Assessment of tolerance and acceptability between mannitol solution and polyethylene glycol as bowel preparation for colonoscopy: a three-center study / Evaluación de tolerancia y aceptabilidad entre la solución de manitol y el polietilenglicol como preparación intestinal para la colonoscopía: un estudio de tres centros

ABSTRACT Introduction: Adequate bowel preparation is one of the most important factors related to the yield of colonoscopy. Low quality bowel preparation has been associated with lower adenoma detection rates and increased healthcare expenses. Bowel preparation is a major impediment to undergo colonoscopy since it is perceived as an unpleasant experience by patients. Objective: This study was aimed to assess tolerance and acceptability of the bowel preparation using either polyethylene glycol (PEG) or mannitol solution. Materials and methods: We enrolled 140 patients with indications of screening for colorectal cancer or with suspected large bowel diseases. They received either mannitol solution or PEG as bowel preparation. Patients were asked to fill a questionnaire about the bowel preparation experience. Results: Patients perceived more burdensome the preparation with PEG than mannitol for the variables nausea overall experience, post-procedure discomfort, disagreeable flavor, volume ingested and cost (p<0.05). A similar tolerance was reported for abdominal pain, bloating and anal irritation (p>0.05). The acceptability was 82.9% and 71.4% in the Mannitol group and in the PEG group, respectively (p=0.10). Conclusion: Acceptance of the bowel preparation between mannitol solution and PEG was comparable. However, mannitol was better tolerated by the patients in regard to most of the evaluated items.

RESUMEN Introducción: La preparación intestinal adecuada es uno de los factores más importantes relacionados con el rendimiento de la colonoscopía. La preparación intestinal de baja calidad se ha asociado con tasas de detección de adenoma más bajas y mayores gastos de atención sanitaria. La preparación intestinal es un impedimento importante para someterse a una colonoscopía, ya que los pacientes la perciben como una experiencia desagradable. Objetivo: Este estudio tuvo como objetivo evaluar la tolerancia y la aceptabilidad de la preparación intestinal utilizando polietilenglicol (PEG) o solución de manitol. Materiales y métodos: Fueron incluidos 140 pacientes con indicación de pesquisa de cáncer colorrectal o con sospecha de enfermedades del intestino grueso. Los pacientes recibieron solución de manitol o PEG como preparación intestinal. Se pidió a los pacientes que completaran un cuestionario sobre la experiencia de preparación intestinal. Resultados: Los pacientes percibieron más agobiante la preparación con PEG que el manitol para las variables náuseas, experiencia general, molestias posteriores al procedimiento, sabor desagradable, volumen ingerido y costo (p<0,05). Se informó una tolerancia similar para el dolor abdominal, distensión abdominal e irritación anal (p>0,05). La aceptabilidad fue de 82,9% y 71,4% en el grupo de manitol y en el grupo de PEG, respectivamente (p=0,10). Conclusión: La aceptación de la preparación intestinal entre la solución de manitol y el PEG fue comparable. Sin embargo, el manitol fue mejor tolerado por los pacientes con respecto a la mayoría de las variables evaluadas.

Evaluation of pH and residual gastric volume after colon preparation with mannitol: prospective randomized study comparing procedure performed after 3 hours versus 6 hours

OBJECTIVES: Our goal was to compare the hydrogen potential (pH) and residual gastric volume (RGV) of patients undergoing colonoscopy after 3 and 6 hours of colon preparation with mannitol. METHODS: We described a prospective randomized trial with a 50:50 allocation rate of two distinct times of colonoscopy after colon preparation with 10% mannitol. We included outpatients aged over 18 years, with no history of gastric surgeries and an American Society of Anesthesiologists (ASA)-rated anesthetic risk below III. Colonoscopy was performed after upper digestive endoscopy at two different times: 3 versus 6-hour after mannitol ingestion. During upper gastrointestinal endoscopy, we measured RGV and evaluated pH with a digital pH meter. Clinical trials.gov: 71123317.9.3001.0065 RESULTS: We randomized a total of 100 participants to the 3 and 6-hour groups, with the patients in the 6-hour group being younger and presenting a higher body mass index (BMI). The intervention did not result in any statistically significant differences between the two groups, neither for the RGV (p=0.98) or the pH (p=0.732). However, the subgroup of patients with diabetes mellitus showed statistically significant higher RGV values in the 3-hour group. CONCLUSION There was no difference between RGV and pH values at 3 versus 6-hour after bowel preparation with mannitol, except for RGV in diabetic patients at 3 hours. As prolonged fasting protocols may result in adverse events such as dehydration and electrolyte imbalance, we can infer that colonic preparation with mannitol in shorter fasting periods, such as 3 hours, can be adopted safely and routinely.

Estudio comparativo entre el uso de manitol y el picosulfato sódico como preparación para colonoscopía / Comparison of colon-cleansing methods in preparation for colonoscopy- comparative of solutions of mannitol and sodium picosulfate

Objetivos: El objetivo del presente estudio es comparar la preparación adecuada del colon con manitol y picosulfato sódico. Evaluar la aceptación de los pacientes, los efectos secundarios y la capacidad de limpieza. Materiales y métodos: Este es un estudio no aleatorio, prospectivo, ciego, en que el evaluador no tenía información sobre la preparación aplicada. La muestra obtenida se dividió en dos grupos de acuerdo con la preparación adecuada del colon, con 153 pacientes preparados con manitol al 10% y 84 pacientes con picosulfato sódico. La evaluación de la preparación se realizó usando la Escala de Boston (Boston Bowel Preparation Scale - BBP) a través de un sistema de puntuación para cada región del colon puntuada con 3 puntos: derecha, izquierda y colon transverso. Resultados: De los 237 pacientes que fueron evaluados, 146 (61,60%) eran mujeres y 91 (38,4%) eran hombres. En el grupo que utilizó manitol, 98 (64,05%) eran mujeres y 55 (35,95%) eran varones. Entre los pacientes que utilizaron picosulfato sódico, 48 (57,14%)eran mujeres y 36 (42,86%) eran hombres, sin diferencias estadísticas de ambos grupos (p>0,32). Teniendo en cuenta que con la adecuada preparación del colon y con puntuación de 6 puntos en la Escala de Boston, la preparación intestinal fue satisfactoria en ambos grupos. El 93% de los pacientes que utilizaron manitol y el 81% de los pacientes que utilizaron picosulfato sódico tenían preparación adecuada (puntuación de 6). La puntuación media en la preparación con manitol fue de 9 y en la preparación con picosulfato sódico fue de 7. No hubo diferencias significativas entre ambos grupos. Conclusión: Ambas preparaciones, demostraron ser seguras y eficaces para la limpieza del intestino, de acuerdo con la Escala de Boston, así como, la aceptabilidad de los pacientes y libre de complicaciones

Objectives: The purpose of the present study is to compare intestinal preparation with mannitol and sodium picosulphate, assessing patient’s acceptance, side effects and cleaning capacity. Material and methods: This is a prospective, nom randomized, blind study, in which the evaluator had no information about the preparation applied. The sample obtained was divided into two groups according to the bowel preparation applied, with 153 patients prepared with 10% mannitol and 84 patients with sodium picosulfate. The evaluation of colon preparation was done using the Boston Scale (Boston Bowel Preparation Scale - BBP) through a three-point scoring system for each of the three regions of the colon: right, left and transverse colon. Results: Of the 237 patients that were evaluated, 146 (61.60%) were female and 91 (38.4%) were male. Regarding the group that used mannitol, 98 were female (64.05%) and 55 were male (35.95%). Among the patients who used sodium picosulfate, 48 were female (57.14%) and 36 were male (42.86%), with no statistical differences between both groups (p> 0.32). Considering that an adequate preparation scores ≥ 6 in the Boston Scale, the bowel cleansing preparation was satisfactory in both groups. 93% of the patients who used mannitol and 81% of the patients who used sodium picosulfate had adequate preparation (score of ≥ 6). Moreover, we consider that the average score in the preparation with Mannitol was 9, while the sodium picosulfate score was 7. There were no significant differences between the two groups. Conclusion: There is consensus among authors who state that colonoscopy’s safety and success are highly related to the cleansing outcome, regardless of the method used. The same can be observed in the present study, on which both preparations were proved safe and effective for bowel cleansing, according to the Boston scale, as well as accepted by patients and free of complications

Bowel preparation for performing a colonoscopy: prospective randomized comparison study between a low-volume solution of polyethylene glycol and bisacodyl versus bisacodyl and a mannitol solution / Preparo de cólon para realização de colonoscopia: estudo prospectivo randomizado comparativo entre solução de polietilenoglicol baixo volume mais bisacodil versus solução de manitol mais bisacodil

CONTEXT: Colonoscopy is currently the gold standard method to examine the colon, the rectum and the terminal ileum. In order to perform the colonoscopy, it is necessary to clean the bowel and use medications that are generally poorly tolerated by the patients. OBJECTIVE: Compare the tolerability, acceptability, safety and efficacy of two solutions used for intestinal preparation for a colonoscopy. METHODS: One hundred patients matched for sex and age were prospective randomized into two groups. Polyethylene glycol group received bisacodyl 10 mg plus 1 L of polyethylene glycol the night before and 1 L on the day of the exam. Mannitol group received bisacodyl 20 mg the day before and 1 L of a 10% mannitol solution on the day of the exam. The diet was the same for both groups. Tolerability and acceptability were measured using previously validated questionnaires. In terms of safety, variations in vital signs before and after the preparation were recorded, in addition to any complications. The quality of the preparation was graded based on the Boston and Ottawa scales. RESULTS: Ninety-six percent (96%) completed the study. As for tolerability, the mannitol preparation group exhibited a significantly higher frequency of nausea, vomiting, abdominal pain, and abdominal distension than polyethylene glycol group (P < 0.05). Acceptability was significantly better in polyethylene glycol group. The polyethylene glycol solution has also previously been shown to be safer than mannitol. No difference was observed in the quality of the preparation between the two preparation methods. CONCLUSIONS: The following conclusions can be made: polyethylene glycol solution had higher tolerability, acceptability, and safety than the mannitol and should be used instead of mannitol. Both preparation solutions have similar efficacy.

CONTEXTO: O exame de colonoscopia é atualmente o padrão-ouro para investigação do cólon e íleo terminal. Para sua realização há necessidade de limpeza do cólon com soluções que, em geral, são mal toleradas pelos pacientes. OBJETIVO: Comparar duas soluções de preparo intestinal para colonoscopia quanto à tolerabilidade, aceitabilidade, segurança e efetividade. MÉTODOS: Cem pacientes pareados por sexo e idade foram randomizados prospectivamente em dois grupos. O grupo polietilenoglicol recebeu bisacodil 10 mg + 1 litro de polietilenoglicol na véspera e 1 litro no dia do exame. O grupo manitol recebeu bisacodil 20 mg na véspera e 1 litro de manitol 10% no dia do exame. A dieta foi a mesma nos dois grupos. A tolerabilidade e aceitabilidade foram aferidas por questionários previamente validados. Quanto à segurança foram avaliados: variação de sinais vitais antes e após o preparo e complicações, além de quaisquer sinais de complicação. A qualidade do preparo foi graduada através das escalas de Boston e Ottawa. RESULTADOS: Noventa e seis pacientes (96%) completaram o estudo. Quanto à tolerabilidade o grupo manitol apresentou manifestação significativamente maior de náusea, vômito, dor abdominal e distensão abdominal do que o grupo polietilenoglicol (P<0,05). Aceitabilidade foi significativamente melhor com o grupo polietilenoglicol. O grupo polietilenoglicol também se mostrou mais seguro. Não se observou diferença na qualidade do preparo entre os métodos. CONCLUSÕES: A solução de polietilenoglicol apresentou melhor tolerabilidade, aceitabilidade e segurança e deve ser usada ao invés da solução de manitol. Ambas as soluções são semelhantes em eficácia.

Severe Hypocalcemia Caused by Absorption of Sorbitol-Mannitol Solution during Hysteroscopy

Hysteroscopic procedure can be complicated by intravascular absorption of irrigating fluid. The clinical features of this complication are similar to transurethral resection of the prostate (TURP) syndrome. There have been few reports on hypocalcemia during endoscopoic surgery and clinical implications of hypocalcemia in TURP syndrome have been underestimated. We report a case of TURP syndrome association with a decreased ionized calcium concentration of 0.53 mM/L after the absorption of a large amount of sorbitol-mannitol solution during hysteroscopy. The hypotension which occurred in TURP syndrome did not respond to vasopressor and inotropic agent but responded to the administration of calcium. This case was also accompanied by hyponatremia, hyperglycemia and lactic acidosis through the metabolism of sorbitol.

Randomized clinical trial comparing sodium picosulfate with mannitol on the preparation FOR colonoscopy in hospitalized patients

BACKGROUND: The cleansing of the colon for a colonoscopy exam must be complete so as to allow the visualization and inspection of the intestinal lumen. The ideal cleansing agent should be easily administered, have a low cost, and minimum collateral effects. Sodium picosulfate together with the magnesium citrate is a cathartic stimulant and mannitol is an osmotic laxative, both usually used for this purpose. AIMS: Assess the colon cleanliness comparing the use of mannitol and sodium picosulfate as well as evaluate the level of patient satisfaction, the presence of foam, pain, and abdominal distension in hospitalized patients undergoing colonoscopy. METHODS: A prospective, randomized, single-blind study with 80 patients that compared two groups: mannitol (40) and sodium picosulfate (40). Both groups received the same dietary orientation. The study was approved by the hospital’s Ethics and Research Committee. The endoscopist was blind to the type of preparation. Outcomes evaluated: level of the colon’s cleanliness, patient’s satisfaction, the presence of foam, abdominal pain and distension, and the duration of the exam. The data was analyzed by means of the chi-squared test for proportions and Mann-Whitney for independent samples. RESULTS: There were no statistically significant differences between the groups in relation to the level of the colon’s cleanliness, patient’s satisfaction, the presence of foam, abdominal pain, and the duration of the exam. Fifteen percent of the exams of the mannitol group were interrupted while from the sodium picosulfate group it was 5 percent. The presence of foam was similar for both groups. The average duration for carrying out the exam was 28.44 minutes for the mannitol group and 35.59 minutes for the sodium picosulfate group. Abdominal distension was more frequent in the mannitol group. If they would have to do the same exam, the answer was that 80 percent said yes from the mannitol group and 92.5 percent...

RACIONAL: A limpeza do cólon para o exame de colonoscopia deve ser completa de modo a permitir a visualização e inspeção do lúmen intestinal. O agente de limpeza ideal deveria ser de fácil administração, com baixo custo e com o mínimo de efeitos colaterais. O picosulfato de sódio juntamente com o citrato de magnésio é um estimulante catártico e o manitol é um laxativo osmótico, ambos geralmente utilizados para este propósito. OBJETIVOS: Verificar a limpeza do cólon comparando o uso de manitol e picosulfato de sódio assim como avaliar o nível de satisfação do paciente, presença de espuma, dor e distensão abdominal em pacientes hospitalizados submetidos a colonoscopia. MÉTODOS: Estudo prospectivo, randomizado, simples-cego com 80 pacientes que comparou dois grupos: manitol (40) e picosulfato de sódio (40). Ambos os grupos receberam a mesma orientação dietética. O estudo foi aprovado pelo Comitê de Ética do hospital e pelo Comitê de Pesquisa. O endoscopista foi cego para o tipo de preparo. Desfechos avaliados: nível de limpeza do cólon, satisfação do paciente, presença de espuma, dor e distensão abdominal e tempo de duração do exame. Os dados foram analisados pelas médias de testes qui-quadrado para proporções e Mann-Whitney para amostras independentes. RESULTADOS: Não houve diferença significativa entre os grupos em relação ao nível de limpeza do cólon, satisfação do paciente, presença de espuma, dor abdominal e tempo de exame. Quinze porcento dos exames do grupo manitol foram interrompidos enquanto que grupo picosulfato de sódio foi de 5 por cento. A presença de espuma foi similar em ambos os grupos. A média de duração do exame foi de 28h 44min para o grupo manitol e 35h 59min para o grupo picosulfato de sódio. A distensão abdominal foi mais freqüente no grupo manitol. Se eles tivessem que repetir o exame, a resposta foi de 80 por cento disse sim do grupo manitol e 92,5 por cento do grupo picosulfato de sódio. CONCLUSÕES: A qualidade do...

Mannitol extravasation during partial nephrectomy leading to forearm compartment syndrome

We present the first known complication of forearm compartment syndrome after mannitol infusion during partial nephrectomy. We stress the importance of excellent intravenous catheter access and constant visual monitoring of the intravenous catheter site during and after mannitol infusion as ways to prevent this complication. Prompt recognition of compartment syndrome with appropriate intervention can prevent long-term sequelae.

Manejo clínico del traumatismo encefalocraneano grave / Clinical management of the severe encephalocranial injuries

El TEC es la causa más frecuente de mortalidad e invalidez en niños y adultos jóvenes. Si bien el neurocirujano no puede prevenir los daños traumáticos primarios, la atención está dirigida a la prevención de los daños secundarios causados por hipotensión, hipoxemia y la prevención de complicaciones intracraneanas y sistémicas. Será fundamental el manejo de la presión intracraneana (PIC) con el fin de mantener una presión de perfusión cerebral (PPC) adecuada. Requiriendo todo paciente con un puntaje de 8 o menos en la escala de coma de glasgow (GCS) monitoreo de su PIC. Descartada la presencia de una lesión susceptible de manejo quirúrgico, las medidas indicadas son la hiperventilación moderada (pCO230-35 mm Hg) y el uso de sustancias hiperosmolares (manitol). En pacientes refractarios a estas medidas deberá discutirse como medida adicional el coma barbitúrico y la craneotomía decompresiva

Bowel preparation for colonoscopy: comparison of mannitol and sodium phosphate: results of a prospective randomized study

METHOD: Eighty patients were prospectively randomized for precolonoscopic cleansing either with 750ml of 10 percent mannitol (Group M) or 180ml of a sodium phosphate preparation (Group NaP). Laboratory examinations before and after preparation on all patients included hemoglobin, hematocrit, sodium, potassium, phosphorous, calcium and serum osmolarity. A questionnaire was used to assess undesirable side effects and patient tolerance to the solution. The quality of preparation was assessed by the endoscopist who was unaware of the solution employed. RESULTS: Statistically significant changes were verified in serum sodium, phosphorous, potassium and calcium between the two groups, but no clinical symptoms were observed. There were no significant differences in the frequency of side effects studied. Six of the eight patients in Group NaP who had taken mannitol for a previous colonoscopy claimed better acceptance of the sodium phosphate solution. The endoscopic-blinded trial reported excellent or good bowel preparation in 85 percent prepared with sodium phosphate versus 82.5 percent for mannitol (p=0.37). CONCLUSIONS: Quality of preparation and frequency of side effects was similar in the two solutions. The smaller volume of sodium phosphate necessary for preparation seems to be related to its favorable acceptance. Nevertheless, the retention of sodium and phosphate ions contraindicates the use of sodium phosphate in patients with renal failure, cirrhosis, ascites, and heart failure.

Reacciones adversas e interacciones medicamentosas en pacientes con edema cerebral / Adverse drug reactions and drug interactions in patients with brain edema

Se realizó un estudio en la Unidad de Cuidados Intensivos e Intermedios del Hospital Clinicoquirúrgico Docente "Saturnino Lora" de Santiago de Cuba, con el objetivo de evaluar reacciones adversas e interacciones medicamentosas detectadas en el tratamiento del edema cerebral. Se aplicó el método de vigilancia intensiva del paciente hospitalizado, adaptado a las condiciones experimentales en una muestra de 65 pacientes. Los datos obtenidos se evaluaron por medio de los algoritmos de Naranjo y de Karch-Lasagna, así como la relación beneficio-riesgo de cada tratamiento y el procesamiento estadístico apropiado. Se detectaron 114 reacciones adversas y 40 interacciones medicamentosas; eventos que luego de relacionarlos con aspectos clínicos y demográficos, se analizaron farmacológicamente. Se proponen medidas terapéuticas al personal del servicio

Manitol y procedimientos neuroanestésicos / Mannitol and neuroanesthesical procedures

El manitol es un diurético hiperosmolar que se ha utilizado durante los últimos treinta años en procedimientos neuroanestésicos. Se han propuesto múltiples mecanismos para explicar su efecto sobre el edema cerebral: deshidratación cerebral ocasionada por aumento de la osmolaridad plasmática, vasoconstricción en respuesta a disminución de la viscosidad sanguínea y disminución de la formación de líquido cefalorraquídeo. Recientemente se ha estudiado su capacidad para reducir el daño isquémico, al disminuir los niveles de radicales libres en las zonas injuriadas. En la actualidad su uso se halla controvertido. entre sus ventajas se encuentran la disminución rápida y relativamente prolongada de la presión intracraneal, la preservación de la función renal y la forma sencilla de administración. Las alteraciones hidroelectrolíticas, la marcada variación interindividual de sus efectos y el riesgo de producir rebotes en la presión intracraneal demuestran que la infusión de manitol no carece de efectos nocivos. Se revisan las principales características farmacocinéticas, farmacodinámicas, indicaciones y efectos adversos del manitol, así como su utilidad en los principales procedimientos neuroanestésicos.

Insuficiência renal aguda induzida por manitol: relato de 1 caso / Acute kidney failure induced by manitol: report of a case

É relatado um caso de paciente submetido a neurocirurgia para clipagem de aneurisma cerebral, que foi tratado no pós-operatório com dose elevada de manitol com o intuito de reduzir a pressäo intracraniana. No terceiro dia de tratamento, foi notada insuficiência renal sendo suspenso o tratamento com rápida recuperaçäo da funçäo renal. Säo discutidos os possíveis mecanismos de nefrotoxicidade pelo manitol e recomendaçöes para a utilizaçäo segura deste medicamento.

Síndrome de Mallory-Weiss associada ao preparo colonoscópico com soluçäo osmótica de manitol: relato de caso e revisäo da literatura / Mallory-Weiss syndrome associated to the colonoscopic preparation with mannitol solution: case report

Na última década foram descritos cinco casos de síndrome de Mallory-Weiss associada ao preparo colonoscópico com polietilenoglicol ou soluçao salina. Neste artigo, os autores revisam a leteratura e relatam o caso de paciente com essa complicaçao após o preparo com manitol.

Colonoscopia: metodo diagnostico e terapeutico / Colonoscopy: diagnostic and therapeutic method

O autor aborda o desenvolvimento historico e tecnico do metodo da colonoscopia, as vantagens proporcionadas pelo emprego do metodo, pricipalmente com os novos recursos adquiridos pelos equipamentos ora empregados. Discorrem sobre as diferentes maneiras da realizacao do preparo do intestino grosso para exame e preconizou o emprego do manitol a 10 por cento. Discutiu-se os aspectos quando a sedacao e analgesia para a realizacao do procedimento com seguranca, a descricao do metodo, as indicacoes e contra-indicacoes.

Resultados de la preparación preoperatoria con Manitol en Cirugía colorrectal y costo de un año de trabajo, 1993-1994 / Output of the preoperatory preparation with Manitol in colorrectal surgery and cost of a year of work, 1993-1994

Se realiza un estudio de los resultados obtenidos con la preparación preoperatoria en la cirugía colorrectal, utilizando el Manitol por vía oral con terapéutica antibiotica complementaria en 20 pacientes operados durante un período comprendido entre julio de 1993 y julio de 1994.Entre sus principales resultados se demostró éste es un método más efectivo y sencillo que la preparación preoperatoria clásica con enemas de arrastre, obteniéndose una preparación adecuada durante todas las intervenciones quirúrgicas programadas, así como su facil aplicación y el reducido número de complicaciones para los pacientes, resultando las ventajas por el ahorro evidente de tiempo al reducirse la estadia preoperatoria, es más cómodo para el paciente y la enfermera y es mucho más económica su aplicación