Background: In the present study, we hypothesized that 3% hypertonic saline (HS) is more effective than 20% mannitol to reduce intracranial pressure (ICP) and to modify brain bulk in patients undergoing an elective supratentorial craniotomy. Materials and Methods: After institutional review board approval, patients scheduled to undergo supratentorial craniotomy were enrolled into this prospective, randomized, double-blind study. The patients were monitored for routine hemodynamic parameters, depth of anesthesia, and ICP. They received 5 mL/kg 20% mannitol (n=20) or 3% HS (n=19) as infusion for 15 minutes. The patients’ ICP values were monitored during hypertonic fluid infusion and throughout 30 minutes after infusion as a primary outcome. Secondary outcomes were hemodynamic variables, serum sodium value, blood gases, and surgeon brain relaxation assessment score (1=relaxed, 2=satisfactory, 3=firm, 4=bulging). In addition, the length of intensive care unit and hospital stay were recorded. Results: Demographic and tumor characteristics were similar between groups. The basal (before hypertonic infusion, ICP_T0) and last (30 min after hypertonic infusion finished, ICP_T45) ICP values were 13.7±3.0 and 9.5±1.9 mm Hg, respectively, for the M group, which were comparable with the corresponding levels of 14.2±2.8 and 8.7±1.1 mm Hg in the HS group (P>0.05). The median amount of ICP reduction between T0 and T45 timepoints were 4 (1 to 7) and 5 (1 to 9) mm Hg for group M and group HS, respectively (P=0.035). Baseline central venous pressure, pulse pressure variation, and serum sodium and lactate values were similar between groups, but the last measured pulse pressure variation and lactate value were lower, and sodium value was higher in group HS than in group M (P<0.05). Duration of hospital and intensive care unit stay were similar between groups. Conclusions: Our results suggest that 3% HS provided more effective ICP reduction than 20% mannitol during supratentorial brain tumor surgery.

The laryngeal mask airway (LMA) is an important airway device that was developed in 1983. From the first classic LMA models up to now, LMA models have been developed that are easily and quickly inserted, provide ventilation at higher airway pressures, have lower cuff pressure, a reduced risk of gastric aspiration and cause fewer stress responses. We aimed to compare the LMA Classic with the LMA Supreme in assessing the success rate and time for insertion, number of attempts and leak pressure. A total of 70 patients of ASA group I or II were included in our study. Regarding the airway device used during surgery, the patients were randomly assigned into two groups: the LMA Supreme group and the LMA Classic group. In order to provide common conditions for inserting the laryngeal mask, insertion was made while the bispectral index was between 50 and 60 and T1 was 0. The success rate of inserting the LMA, the duration of insertion, the number of attempts, the insertion complications, ventilation parameters, haemodynamic parameters and postoperative adverse effects were recorded for each group. In the LMA Classic group and the LMA Supreme group, the LMA was successfully inserted in 27 (88.5%) and 34 (97%) patients, respectively. The duration of insertion in the LMA Supreme group was shorter and the cuff pressure was lower than that in the LMA Classic group (P < 0.001). The LMA Supreme is superior to the LMA Classic because of its ease of insertion with low cuff pressure and high oropharyngeal leakage pressure.

Sedative and analgesic treatment administered to critically ill patients need to be regularly assessed to ensure that previously stated goals are well achieved as the risk of complications of oversedation is minimized. We revised and prospectively tested the Ramsay Sedation Scale (RSS) for interrater reliability and compared it with the Riker Sedation-Agitation Scale (RSAS) and the Richmond Agitation Sedation Scale (RASS) to test construct validity during midazolam-remifentanil sedation. A convenience sample of ICU patients was simultaneously and independently examined by pairs of trained evaluators by using the revised RSAS, RSS, and RASS. Ninety-two ICU patients were examined a total of 276 times by evaluator pairs. The mean patient age was 61.32±18.68years, 45,7% were female (n=42), 54.3% male (n=50). Their APACHE values varied between 3 and 39 with an average of 13.27±7.86 and 75% of the cases were under mechanical ventilation. When classified by using RSS (2.70±1.28), 10.9% were anxious or agitated (RSS1), 68.5% were calm (RSS 2-3), and 20.6% were sedated (RSS 4-6). When classified by using RASS (-0.64±1.58), 20.7% were anxious or agitated (RASS+1 to +4), 63.0% were calm (RASS 0 to -2), and 16.3% were sedated (RASS -3 to -5). When classified by using RSAS (2.63±1.00), 12% were anxious or agitated (RSAS 5-7), 57.6% were calm (RSAS 4), and 30.4% were sedated (RSAS 1-3). RSS was correlated with the RSAS (r=-0.656, p<0.001) and RASS was correlated with the RSAS (r=0.565, p<0.001). RSS was highly correlated with the RASS (r=-0.664, p<0.001). Ramsay is both reliable and valid (high correlation with the RASS and RSAS scales) in assessing agitation and sedation in adult ICU patients.