Agents for cerebral edema.

Hyperventilation, ventricular drainage, and mannitol remain the mainstays of the treatment of cerebral edema not amenable to or following surgical therapy. There appears to be good therapeutic rationale for the use of "low-dose" mannitol in more prolonged treatment of intracranial hypertension (Table 5.1). The beneficial effects of steroids, either in "standard" or "high" doses, is less clear but, pending evidence to the contrary, we favor the use of "high-dose" corticosteroid therapy. Barbiturates appear to hold promise, but pending controlled, randomized trials to confirm or refute their efficacy, the logistics of their use, as well as their potential complications, precludes their widespread use outside of major centers. Certainly, the "ideal" agent for the treatment of cerebral edema, one that would selectively mobilize and/or prevent the formation of edema fluid with a rapid onset and prolonged duration of action, and with minimal side effects, remains to be discovered. In the meantime, research to refine the use of the older agents and determine the usefulness of the newer ones should be encouraged.