Use of mannitol during neurosurgery: Interpatient variability in the plasma and CSF levels
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An i.v. infusion of mannitol was given over 15 min to 12 patients before they underwent intracranial surgery under general anesthesia. Samples of blood, CSF and urine were taken over 4 h.
Mannitol disappeared from plasma in a bi-exponential manner. The mean maximal plasma concentration was 4.08 mg/ml at 15 min, and at 4 h it had declined to 0.53 mg/ml. The mean distribution rate constant was 11.2 h−1, corresponding to a plasma distribution half-life of 0.11 h. The mean elimination rate constant was 0.41 h−1, the plasma half-life was 2.2 h, the central distribution volume was 16.31, and total plasma clearance was 100.4 ml/min. The mean concentration of mannitol in CSF during the 4 h period increased up to 0.10 mg/ml. There were marked interindividual differences in the concentration ratio blood/CSF, and the CSF concentration varied 7.5 fold between patients.
Optimal use of mannitol during neurosurgery requires further prolonged study of its pharmacokinetics.
Key wordsmannitol neurosurgery pharmacokinetics interpatient variability CSF kinetics
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