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Effect of the combination of mannitol and ringer acetate or hydroxyethyl starch on whole blood coagulation in vitro.
J Neurosurg Anesthesiol. 2010 Jan; 22(1):16-20.JN

Abstract

Mannitol is administered to decrease the intracranial pressure and to improve surgical conditions during craniotomy. Simultaneously a crystalloid infusion is always given and sometimes hydroxyethyl starch (HES) is indicated for intravascular volume replacement. As normal coagulation profile is required during craniotomy, we aimed at determining the effect of mannitol with or without HES or Ringer acetate on blood coagulation in this randomized cross-over in vitro study. Blood samples were withdrawn from 10 volunteers. From whole blood we prepared 10 vol.% and 20 vol.% dilutions of mannitol (15% Mannitol) alone, mannitol and Ringer acetate, and mannitol and HES 130/0.4 (Voluven) at a ratio of 1:1. Blood samples were analyzed by modified thromboelastometry. Coagulation parameters: clotting time, clot formation time, and maximum clot firmness (MCF), were registered. Clot formation time was prolonged in all dilutions compared with control (P<0.05). MCF decreased in all dilutions compared with control (P<0.05). MCF in 20 vol.% dilution of mannitol with HES was lower than MCF in the corresponding dilution with Ringer acetate (P<0.05). Fibrinogen-dependent MCF in 10 vol.% dilution of mannitol with HES was lower than MCF in the corresponding dilution with Ringer acetate (P<0.05). We conclude that mannitol in combination with HES 130/0.4 impairs clot propagation and clot strength in vitro. Fibrin clot strength impairment is more pronounced when mannitol is combined with HES than Ringer acetate. Our findings indicate that HES in combination with mannitol should be avoided whenever a disturbance in hemostasis is suspected during craniotomy.

Authors+Show Affiliations

Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland. Ann-Christine.Lindroos@hus.fiNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19816205

Citation

Lindroos, Ann-Christine, et al. "Effect of the Combination of Mannitol and Ringer Acetate or Hydroxyethyl Starch On Whole Blood Coagulation in Vitro." Journal of Neurosurgical Anesthesiology, vol. 22, no. 1, 2010, pp. 16-20.
Lindroos AC, Schramko A, Tanskanen P, et al. Effect of the combination of mannitol and ringer acetate or hydroxyethyl starch on whole blood coagulation in vitro. J Neurosurg Anesthesiol. 2010;22(1):16-20.
Lindroos, A. C., Schramko, A., Tanskanen, P., & Niemi, T. (2010). Effect of the combination of mannitol and ringer acetate or hydroxyethyl starch on whole blood coagulation in vitro. Journal of Neurosurgical Anesthesiology, 22(1), 16-20. https://doi.org/10.1097/ANA.0b013e3181bd4ede
Lindroos AC, et al. Effect of the Combination of Mannitol and Ringer Acetate or Hydroxyethyl Starch On Whole Blood Coagulation in Vitro. J Neurosurg Anesthesiol. 2010;22(1):16-20. PubMed PMID: 19816205.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of the combination of mannitol and ringer acetate or hydroxyethyl starch on whole blood coagulation in vitro. AU - Lindroos,Ann-Christine, AU - Schramko,Alexey, AU - Tanskanen,Päivi, AU - Niemi,Tomi, PY - 2009/10/10/entrez PY - 2009/10/10/pubmed PY - 2010/3/31/medline SP - 16 EP - 20 JF - Journal of neurosurgical anesthesiology JO - J Neurosurg Anesthesiol VL - 22 IS - 1 N2 - Mannitol is administered to decrease the intracranial pressure and to improve surgical conditions during craniotomy. Simultaneously a crystalloid infusion is always given and sometimes hydroxyethyl starch (HES) is indicated for intravascular volume replacement. As normal coagulation profile is required during craniotomy, we aimed at determining the effect of mannitol with or without HES or Ringer acetate on blood coagulation in this randomized cross-over in vitro study. Blood samples were withdrawn from 10 volunteers. From whole blood we prepared 10 vol.% and 20 vol.% dilutions of mannitol (15% Mannitol) alone, mannitol and Ringer acetate, and mannitol and HES 130/0.4 (Voluven) at a ratio of 1:1. Blood samples were analyzed by modified thromboelastometry. Coagulation parameters: clotting time, clot formation time, and maximum clot firmness (MCF), were registered. Clot formation time was prolonged in all dilutions compared with control (P<0.05). MCF decreased in all dilutions compared with control (P<0.05). MCF in 20 vol.% dilution of mannitol with HES was lower than MCF in the corresponding dilution with Ringer acetate (P<0.05). Fibrinogen-dependent MCF in 10 vol.% dilution of mannitol with HES was lower than MCF in the corresponding dilution with Ringer acetate (P<0.05). We conclude that mannitol in combination with HES 130/0.4 impairs clot propagation and clot strength in vitro. Fibrin clot strength impairment is more pronounced when mannitol is combined with HES than Ringer acetate. Our findings indicate that HES in combination with mannitol should be avoided whenever a disturbance in hemostasis is suspected during craniotomy. SN - 1537-1921 UR - https://www.unboundmedicine.com/medline/citation/19816205/Effect_of_the_combination_of_mannitol_and_ringer_acetate_or_hydroxyethyl_starch_on_whole_blood_coagulation_in_vitro_ L2 - https://doi.org/10.1097/ANA.0b013e3181bd4ede DB - PRIME DP - Unbound Medicine ER -