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Canadian Journal of Anesthesia, Vol 32, 506-515, Copyright © 1985 by Canadian Anesthesiologists' Society

The Effects of Rapid Infusions of Saline And Mannitol on Cerebral Blood Volume and Intracranial Pressure in Dogs

P. RAVUSSIN MD1, D. P. ARCHER MD1, E. MEYER PHD1, M. ABOU-MADI MD1, L. YAMAMOTO MD1, and D. TROP MD1

1 Department of Neuroanaesthesia and the Cone Laboratory for Neurosurgical Research, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec

Address correspondence to: D.P. Archer, M.D., Department of Neuroanaesthesia, Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, Quebec, Canada, H3A 2B4

The role of osmotic brain dehydration in the early reduction of intracranial pressure (ICP) following mannitol administration has recently been questioned and a decrease in cerebral blood volume (CBV) proposed as the mechanism of action. To evaluate this hypothesis, relative CBV changes before and after mannitol infusion were determined by collimated gamma counting across the biparietal diameter of the exposed skull in six dogs. Red blood cells were labelled with chromium-51. Cerebral blood volume (CBV), total blood volume (TBV), ICP, mean arterial pressure (MAP), central venous pressure (CVP), haematocrit and osmolality were serially measured after infusions of 10 ml·kg-1 of normal saline (control study) and of 20 per cent mannitol (mannitol study). The solutions were administered over a two minute period; a 30-minute equilibration period intervened between the saline and mannitol infusions.

We demonstrated that the mannitol infusion was associated with significant increases in relative CBV (25 per cent), ICP (7 mmHg), CVP (11 cm H2O), and TBV (50 per cent). MAP declined significantly (14 per cent) after mannitol infusion. The administration of saline, although associated with an increase in TBV (18 per cent), was not associated with any significant change in CBV, ICP, MAP or CVP.

The increase in relative CBV persisted for 15 minutes after mannitol infusion, while the ICP returned to control within five minutes and continued to decrease. This study supports the fact that after rapid mannitol infusion, ICP begins to decrease only once the dehydrating effect has counteracted the increase in brain bulk caused by the increase in cerebral blood volume.

Key Words: FLUID BALANCE: mannitol • BRAIN: intracranial pressure, oedema, cerebral blood volume






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Copyright © 1985 by the Canadian Anesthesiologists' Society.