Effects of mannitol in the prevention of lipid peroxidation during liver resection with hepatic vascular exclusion

Study Objective: To examine the efficacy of mannitol in the prevention of lipid peroxidation during major liver resections performed during hepatic inflow occlusion. Design: Prospective, randomized, open-label study. Setting: Aretaieion Hospital, a university-affiliated hospital. Patients: 30 ASA physical status II and III patients, less than 75 years of age, scheduled for elective liver resection. Interventions: All patients received combined general and epidural anesthesia. Laparotomy was performed through a bilateral subcostal incision, and hepatectomy was performed by inflow vascular exclusion (Pringle's maneuver). Before this maneuver, and if the patients were hemodynamically stable, they were randomized to receive either mannitol 20% 1.5 mL kg(-1) (group M) or normal saline 1.5 mL kg(-1) (group S) intravenously for 30 minutes. Measurements: Venous blood malondialdehyde (MDA) concentration, as an index of lipid peroxidation, was measured spectrophotometrically at selected time points. Main Results: Patients in both groups presented with raised MDA values (P < 0.05) for the period starting before the release of vascular occlusion until 6 days postoperatively. In patients receiving mannitol, lower MDA values were observed (P < 0.05) compared with group S at the end of operation. Conclusion: Mannitol has an antioxidant activity, but we were unable to confirm a positive impact on the postoperative clinical course. (C) 2006 Elsevier Inc. All rights reserved.