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Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 2 2012 83
Mannitol: a review of its clinical uses
to cause thrombophlebitis. Side-effects include rebound increases Mannitol also reduces post-ischaemic endothelial cell swelling and
in ICP, volume overload, coagulopathy, and electrolyte abnormal- decreases ischaemic –reperfusion injuries through scavenging of
ities, particularly hypernatraemia and hyperchloraemic metabolic hydroxyl and other free radicals.
acidosis.
Cardiac surgery
Renal protection The incidence of ARF after cardiac surgery is around 5% and its
Mannitol has been promoted as a renal protective agent in patients development is associated with a mortality of 10–20%. It is
at high risk of developing renal failure, such as those undergoing particularly common when cardiopulmonary bypass times exceed
84 Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 2 2012
Mannitol: a review of its clinical uses
12.5 –25 g of mannitol every 6 h until the myoglobinuria resolves The Cochrane group analysed 18 randomized controlled trials
or until the serum osmolarity exceeds 320 mOsm litre21. comparing bowel preparation with no preparation before elective
However, there are no well-designed studies that demonstrate an colorectal surgery and identified no difference in the incidence of
advantage of mannitol, either alone or in combination with other anastomotic leakage or wound infection.12 Routine bowel prepar-
diuretics, over adequate hydration in improving urinary flow and ation, including the use of oral mannitol, should therefore be elimi-
prevention of myoglobin casts after rhabdomyloysis.8 nated from clinical practice.
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 2 2012 85