Brain Tumors
Conditions
Keywords
Brain Tumors, Microcirculation, Osmotherapy, Hypertonic NaCl, Natremia
Brief summary
Hyperosmotic solutions of 1.5% and 3% NaCl are equally effective for brain relaxation and microcirculation during brain surgery. The effect of 1.5% NaCl on postoperative natremia and natriuresis is less pronounced.
Detailed description
All the patients meeting the study criteria will be randomized into two groups. After standardized induction to general anesthesia all patients will be given the infusion of hyperosmotic NaCl 5 ml/kg/BW during 30 min, group A 1.5% NaCl, group B 3% NaCl. Corticosteroids will be administered as usually. After dura opening the brain relaxation score will be assessed by surgeon (1 = completely relaxed, 2 = satisfactorily relaxed, 3 = firm brain, 4 = bulging brain), and the first measurement of the brain microcirculation provided by use of SDF probe in the area of the healthy brain, and of perifocal oedema. Both sites of investigation will be marked for the second measurement, which will be done after the end of tumor resection. Laboratory examinations: natremia preoperatively, natremia and osmolarity peroperatively 1 hour after NaCl infusion and at the end of surgery. Concentration of natrium will be examined in CSF after dura opening. Anesthesia management will be according to the standardised protocol, the patients will be awaken and extubated after the end of the procedure at the operating theatre.
Interventions
PROCEDURE1.5% NaCl
After the infusion of 1.5% NaCl and dura opening the microcirculation and the brain relaxation score will be measured in the area of healthy brain and perifocal oedema sites. Microcirculation measurement will be repeated at the same sites after tumor resection.
PROCEDURE3% NaCl
After the infusion of 3% NaCl and dura opening the microcirculation and the brain relaxation score will be measured in the area of healthy brain and perifocal oedema sites. Microcirculation measurement will be repeated at the same sites after tumor resection.
Sponsors
University Hospital Hradec Kralove
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* peripheral supratentorial brain tumors or metastasis * indication for osmotherapy * ASA status I-III
Exclusion criteria
* reoperation * osmotherapy prior to surgery * preoperative natremia less than 135 mmol/l and more than 140 mmol/l * GCS less than 14 * obstructive hydrocephalus
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in brain microcirculation | from dura opening till the end of tumor resection | measurement by SDF probe MicroVision |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes in natremia | 1 hour after hypertonic NaCl infusion | mmol/l |
| Changes in osmolarity | 1 hour after hypertonic NaCl infusion | mosm/l |
| Concentration of natrium in cerebrospinal fluid | after dura opening | mmol/l |
Other
| Measure | Time frame | Description |
|---|---|---|
| Changes in diuresis | at the time of extubation | ml/hour |
Countries
Czechia
Outcome results
None listed