الفهرس 
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Abstract
In neurosurqical operations, the brain dehydration is essential to make the brain easily retractable to facilitate the exposure of deep structures. This brain dehydration can be obtained by employing diuretic therapy which is achieved by combined osmotic-loop diuretics (mannitol, furosemide). Marked brain dehydration is due to the synergistic action of the two diuretics.
Combined osmotic-loop diuretics may cause electrolyte imbalance which may results in undesirable side effects. On the other hand, this combination may be of value in patients with rapid brain swelling and poorly compensated cardiovascular status .
This work aimed to compared the effects of using mannitol
versus osmotic-loop diuresis using mannitol and furosemide on plasma and CSF electrolytes and ion excretion in brain surgery.
This study was carried out in Alexandria Main University
Hospital. On twenty adult patients of both sexes scheduled for brain surgery.
Atropine sulphate (0.3-0.6 mg) intramuscular was used for premedication half an hour before the operation.
In every patient a cannula 20 gauge was inserted in radial artery. Another cannula 18 gauge was placed in a peripheral vein. Preoperative CSF samples was taken through the lumbar subarachnoid space, while the patient in lateral
position.
Anaesthesia was induced by thiopentone sodium (4-7 mg/kg) then pancuronium bromide (0.06-0.1 mg/kg) for intubation.
Maintenance of anaesthesia was done by using oxygen 8 litter/min, with halothane 1% with supplementary doses of
pancuronium bromide .
All patients were mechanically ventilated with a tidal volume of 500 ml and respiratory rate of 20 per minute.
109 Indwelling catheter was placed in the superior vena cava
and the urinary bladder was then catheterized.
The patients were divided into two equal groups according to diuretic agent used :
Group I :
Ten patients received mannitol 15% (1-3.5 gm/kg) as rapid infusion over 20 minutes after induction.
Group II :
Ten patients received mannitol 15% (1-3.5 gm/kg) as rapid infusion over 20 minutes after induction plus furosemide (0.3 mg/kg) which was given after infusion of the first 100 ml of mannitol.
Intracranial pressure was measured directly using interventricular catheter and water manometer before diuresis and after 30, 60, and 120 minutes from starting diuresis.
The following samples were taken :
1. Arterial blood samples for oxygen tension (Pa O2) , arterial carbon dioxide tension (Pa Co2) and pH.
2. Blood samples for measurement of serum sodium, potassium and chlor ide .
3. Urine samples for measurement of electrolytes (sodium, potassium and chloride).
4. Cerebrospinal fluid sample for measurement of.
electrolytes (sodium, potassium and chloride).
All samples were taken before diuretic administration, 30, 60 and 120 minutes after administration. Except the CSF samples were taken before diuretic administration and 120 minutes after administration.
The following results were obtained ; 1. Serum electrolytes :
In group I serum sodium and chloride showed a significant decrease after 30, 60 and 120 minutes from the pre-diuresis value, while serum potassium showed a significant decrease only after 30, 60 minutes from the pre-diuresis value while the decrease was insignificant after 120 minutes.
In group II a significant decrease was observed in serum
sodium, potassium and chloride after 30, 60 and 120 minutes from the pre-diuresis value.
Comparing both groups, there was a significant decrease in serum sodium, potassium and chloride in group II more than group I after 30, 60 and 120 minutes.
2. Urjnary electrolytes :
In group I urinary sodium and chloride showed a significant increase after 30, 60 and 120 minutes from the pre-diuresis value, while urinary potassium showed a significant increase after 30, 60 minutes only from the pre-diuresis value, and the increase was • insignificant after 120 minutes .
In group II a significant increase was observed in urinary sodium and chloride after 30, 60 and 120 minutes from the pre-diuresis value, while urinary potassium showed a significant increase alter. Id, $>Q> ^v^tts tynV? i^Din ”One pre-diuresis value and the increase was an insignificant after 120 minutes.
Comparing both groups, there was a significant increase
in urinary sodium, potassium and chloride in group II more
than group I after 30, 60 and 120 minutes.
3. CSF electrolytes :
In group I a significant decrease was observed in CSF sodium, potassium and chloride after 120 minutes from the pre-diuresis value.
In group II CSF sodium, potassium and chloride showed a significant decrease after 120 minutes from the pre-diuresis
value .
There was a significant decrease in CSF sodium after 120 minutes, while CSF potassium and chloride showed insignificant decrease after 120 minutes in group II when compared to group I .
4. Intracranial pressure (ICP):
In group I a significant decrease was observed in ICP after 30, 60 and 120 minutes from the pre-diuresis value. In group II ICP showed a significant decrease after 30,
60 and 120 minutes from the pre-diuresis value.
Comparing both groups, there was a significant decrease after 30, 60, 120 minutes in group II when compared to group I.
4. No statistically significant change could be detected in arterial oxygen tension, carbon dioxide tension or pH between the two groups.