Furosemide vs Placebo for Brain Relaxation

NCT ID: NCT01054404

Last Updated: 2013-08-02

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

23 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-02-28

Study Completion Date

2012-03-31

Brief Summary

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Increased brain bulk may be problematic during brain surgery for tumors because it may limit surgical exposure and access to the surgical site. Mannitol, an osmotic diuretic, is commonly given to alleviate brain bulk, and sometimes furosemide in a small dose is added if mannitol alone is insufficient. It is unclear if adding this furosemide truly helps to diminish brain bulk, and it is possible that furosemide may cause too much diuresis, leading to dehydration and its side effects (e.g., low blood pressure). Our purpose is to investigate what the effects of furosemide are in the setting of brain surgery for tumors, specifically with regards to decreasing brain bulk and/or causing dehydration.

Study Hypothesis: The addition of furosemide to mannitol will result in improved brain relaxation in human subjects undergoing craniotomy for brain tumor resection than that seen with mannitol alone. However, the combination of mannitol and furosemide will also lead to more significant intravascular volume depletion than that seen with mannitol alone.

Detailed Description

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Rating of brain relaxation will be on a 4-point scale:

0 = brain very relaxed under dura, acceptable

1. = brain adequately relaxed under dura, acceptable
2. = brain slightly tense under dura, acceptable
3. = brain very tense under bulging dura, unacceptable

Conditions

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Brain Swelling Brain Edema Dehydration

Keywords

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Brain Swelling Brain Edema Dehydration

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Furosemide

Furosemide 0.3 mg/kg

Group Type ACTIVE_COMPARATOR

Furosemide

Intervention Type DRUG

Furosemide 0.3 mg/kg

Placebo

Up to 5 mL saline

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Placebo (up to 5mL)

Interventions

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Furosemide

Furosemide 0.3 mg/kg

Intervention Type DRUG

Placebo

Placebo (up to 5mL)

Intervention Type DRUG

Other Intervention Names

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Lasix Saline

Eligibility Criteria

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Inclusion Criteria

* ASA PS I-III
* Age 18 or older
* Presenting for elective resection of primary or metastatic supratentorial brain tumor(s)

Exclusion Criteria

* • ASA PS IV or V

* Age less than 18
* Emergency surgery due to severely elevated ICP/impending brainstem herniation
* Concurrent use of diuretics for any indication
* Infratentorial/posterior fossa/cerebellar tumor resection
* Moderate/severe cardiac disease with limitation in contractility as measured by preoperative echocardiogram (EF \< 30%)
* Severe pulmonary hypertension as measured and/or observed by preoperative studies
* Preoperative use of steroids (within 6 months, including those on standing doses)
* Pregnancy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Northwestern University

OTHER

Sponsor Role lead

Responsible Party

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John Bebawy

Assistant Professor of Anesthesiology & Neurological Surgery

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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John F Bebawy, MD

Role: PRINCIPAL_INVESTIGATOR

Northwestern University

Dhanesh K Gupta, MD

Role: STUDY_DIRECTOR

Northwestern University

Locations

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Northwestern University

Chicago, Illinois, United States

Site Status

Countries

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United States

References

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Thenuwara K, Todd MM, Brian JE Jr. Effect of mannitol and furosemide on plasma osmolality and brain water. Anesthesiology. 2002 Feb;96(2):416-21. doi: 10.1097/00000542-200202000-00029.

Reference Type BACKGROUND
PMID: 11818776 (View on PubMed)

Todd MM, Cutkomp J, Brian JE. Influence of mannitol and furosemide, alone and in combination, on brain water content after fluid percussion injury. Anesthesiology. 2006 Dec;105(6):1176-81. doi: 10.1097/00000542-200612000-00017.

Reference Type BACKGROUND
PMID: 17122580 (View on PubMed)

Rudehill A, Lagerkranser M, Lindquist C, Gordon E. Effects of mannitol on blood volume and central hemodynamics in patients undergoing cerebral aneurysm surgery. Anesth Analg. 1983 Oct;62(10):875-80.

Reference Type BACKGROUND
PMID: 6412595 (View on PubMed)

Todd MM, Warner DS, Sokoll MD, Maktabi MA, Hindman BJ, Scamman FL, Kirschner J. A prospective, comparative trial of three anesthetics for elective supratentorial craniotomy. Propofol/fentanyl, isoflurane/nitrous oxide, and fentanyl/nitrous oxide. Anesthesiology. 1993 Jun;78(6):1005-20. doi: 10.1097/00000542-199306000-00002.

Reference Type BACKGROUND
PMID: 8512094 (View on PubMed)

Rozet I, Tontisirin N, Muangman S, Vavilala MS, Souter MJ, Lee LA, Kincaid MS, Britz GW, Lam AM. Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anesthesiology. 2007 Nov;107(5):697-704. doi: 10.1097/01.anes.0000286980.92759.94.

Reference Type BACKGROUND
PMID: 18073543 (View on PubMed)

Other Identifiers

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STU00016126

Identifier Type: -

Identifier Source: org_study_id