COMBINATION OF 10 PERCENT MANNITOL WITH 10 PERCENT GLYCERINE VERSUS 20 PERCENT MANNITOL FOR INTRAOPERATIVE BRAIN RELAXATION IN PATIENTS WITH ACUTE ANEURYSMAL SUBARACHNOID HAEMORRHAGE UNDERGOING CRANIOTOMY AND CLIPPING OF ANEURYSM

Brain relaxation is an important aspect of anesthetic care during intracranial surgery. Optimal brain relaxation improves the surgeon’s operating conditions and is likely to minimize the severity of retraction injury.1 Brain relaxation should be used to describe a clinical entity that has anesthetic, surgical, physiological, and outcome implications 2 . Moreover, they are often recognized as contributors to secondary brain injury, devastating neurological outcomes, and even brain death,

The combination of mannitol and glycerol comprises a combination of two sugars with better osmotic diuretic properties. Either glycerol or mannitol can be administered individually; however, the addition of glycerol to mannitol allows the lower concentration of the agents, hereby, minimizes the side effects of both agents. There is insufficient data to compare the effect of 20% mannitol plus 10% glycerol combination and 20% mannitol with a similar osmotic load in patients with aneurysmal subarachnoid haemorrhage (aSAH). These two drugs, combination of mannitol plus glycerol and mannitol are nearly equimolar. The osmolarity of combination of mannitol plus glycerol is 1049 and mannitol is 1098.Hence the study is planned to compare the brain relaxation score with the combination of mannitol with glycerine versus mannitol alone in patients with aSAH undergoing craniotomy and clipping.