Use of mannitol during neurosurgery: interpatient variability in the plasma and CSF levels

• Published in: European journal of clinical pharmacology 1988-01, Vol.35 (6), p.643-649
• Main Authors: ANDERSON, P, BOREUS, L, GORDON, E, LAGERKRANSER, M, RUDEHILL, A, LINDQUIST, C, OHMAN, G
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Brain - surgery; Cardiovascular system; Female; Gas Chromatography-Mass Spectrometry; Humans; Infusions, Intravenous; Male; Mannitol - blood; Mannitol - cerebrospinal fluid; Mannitol - pharmacokinetics; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Vasodilator agents. Cerebral vasodilators
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/BF00637601

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 16.3 l, 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.