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NEUROSURGICAL ANESTHESIA

The Effect of Treatment with Albumin, Hetastarch, or Hypertonic Saline on Neurological Status and Brain Edema in a Rat Model of Closed Head Trauma Combined with Uncontrolled Hemorrhage and Concurrent Resuscitation in Rats

Israel Eilig, MD^*, Maxim Rachinsky, MD^*, Alan A. Artru, MD, Andrei Alonchin, MD, Vadim Kapuler, MD^§, Alexander Tarnapolski, MD^*, and Yoram Shapira, MD PhD^*

*Division of Anesthesiology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington; and the Departments of Neurosurgery and §Pediatric Surgery, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Address correspondence to Alan A. Artru, MD, Department of Anesthesiology, Box 356540, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6540. Address e-mail to artruaa{at}u.washington.edu Reprints will not be available from the author.

In rats subjected to closed head trauma (CHT) plus uncontrolled hemorrhage, giving 0.3 mL of 0.9% saline per 0.1 mL of blood lost did not restore mean arterial blood pressure (MAP) or improve neurological severity score (NSS). In CHT without hemorrhage, giving 20% albumin or 10% hetastarch improved NSS. We hypothesized that these latter treatments would also improve NSS after CHT plus uncontrolled hemorrhage. Rats were randomly assigned to one of seven groups. Experimental conditions were CHT (yes or no), uncontrolled hemorrhage (yes or no), and fluid given to replace blood loss (none; 10% hetastarch, 20% albumin, or 3% saline [0.1 mL per 0.1 mL of blood lost]; or 0.9% saline [0.3 mL per 0.1 mL of blood lost]). NSS (0–25 scale, where 0 = no impairment) was determined at 1, 4, and 24 h, and brain water content was determined at 24 h after CHT. NSS (median ± range) at 24 h was 11 ± 6 when no fluid was given; 16 ± 5 with 10% hetastarch; 14 ± 5 with 20% albumin; 12 ± 4 with 3% saline; and 13 ± 4 with 0.9% saline given (not significant). In addition, brain water content and MAP did not differ among the groups receiving CHT with or without uncontrolled hemorrhage. In our model of CHT plus uncontrolled hemorrhage in rats, giving 10% hetastarch, 20% albumin, 3% saline, or 0.9% saline failed to improve NSS, brain water content, or MAP.

Implications: In previous studies of closed head trauma (CHT) without hemorrhage, giving 20% albumin or 10% hetastarch improved neurological severity scores (NSSs). We hypothesized that these treatments also might be beneficial in CHT plus uncontrolled hemorrhage. We found that giving 10% hetastarch, 20% albumin, 3% saline, or 0.9% saline failed to improve NSS, brain water content, or mean arterial blood pressure.

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				H. White, D. Cook, and B. Venkatesh The use of hypertonic saline for treating intracranial hypertension after traumatic brain injury. Anesth. Analg., June 1, 2006; 102(6): 1836 - 1846. [Abstract] [Full Text] [PDF]