[Early detection of TUR(transurethral resection) syndrome--ethanol measurement in ventilated patients]

Does an alcolmeter in the hands of an anesthesiologist make TURP safer? - Results from a case-control study

BACKGROUND

This hospital-based, prospective, case-controlled study was carried out to monitor fluid absorption during transurethral resection of the prostrate (TURP) by marking the irrigating fluid with ethanol for signs of TURP syndrome. Addition of ethanol allows early detection and prevention of full blown TURP syndrome as also the volume of fluid absorbed can be measured.

SUBJECTS AND METHODS

Patients were divided into two groups of 50 each, taking males undergoing TURP belonging to ASA (American Society of Anesthesiologists) I and II. Group 1 received irrigation with 1.5% glycine alone and group 2 received irrigation with 1.5% glycine along with ethanol during TURP. The primary outcome measure was the detection of TURP syndrome using end expiratory ethanol levels and comparing with serum electrolytes and clinical manifestations. The secondary outcome measures, the hemodynamic parameters such as heart rate, systolic and diastolic pressures, and oxygen saturation were recorded during the intraoperative period after spinal anesthesia and then postoperatively till the end of the first hour in the recovery room.

STATISTICAL ANALYSIS

Chi-square test, Student's t-test and Pearson's correlation coefficient 'r'.

RESULTS

Mean resection time in the ethanol positive patients (36.36 min) was significantly higher than that in the ethanol negative patients (22.08 min) (P < 0.01). The estimated fluid absorbed was statistically significant in 45 minutes of resection in three patients with positive ethanol readings (P < 0.05). Resection was temporally stopped in 16 patients (32%) and permanently in 1 patient (2%), whose resection time reached 60 min. A positive correlation was found between total fall in serum sodium and maximum expiratory ethanol concentration. There was a significant difference in the heart rate between the two groups in the 40(th) minute (P < 0.05).

CONCLUSION

Ethanol is a noninvasive, easy-to-use marker in irrigating fluid for assessing fluid absorption. It forewarns to take corrective measures earlier than both fall in sodium and manifestations of TURP syndrome, allowing successful completion of TURP.

Evaluation verfahrensspezifischer Risikopotentiale der Wasserabrasivstrahl – Osteotomie in-vivo / Evaluation of potential risks of abrasive water jet osteotomy in-vivo

Since the 80's the water jet scalpel is an established tool in some surgical fields. It is used in particular in visceral surgery for preparation of parenchymatous organs. By the addition of biocompatible abrasives, this technique is able to effectively machine hard biological tissues. Free defined cutting geometries can be realised in a non contact process. Therewith this method has crucial advantages compared to conventional osteotomy techniques and gives new impulses to the development in endoprosthetics and correction osteotomies of hollow bones. In the presented work the new developed abrasive water injection jet (AWIJ) was used the first time for in-vivo osteotomies. Aim of this study was the detection of potential thrombembolic effects and wash in effects of the cutting fluid. Hollow bones of the fore and hind leg of 20 house pigs were treated with the new cutting technique. Intraoperative documentation of relevant vital parameters was performed by a multi monitoring system. Thrombembolic effects during the osteotomy were detected by transthoracic Doppler ultrasonography and transesophagale echocardiography. The hollow bones were prepared in consideration of the vascularisation's protection especially in respect to the venous flow. Thrombembolic effects with temporary haemodynamic respectively respiratory consequences could be detected exclusively by using the so called "3-component jet", which consists of 90 vol % of air. The usage of an abrasive suspension enables the airfree dosing of dry soluable abrasives. Thrombembolic effects could not be monitored in this case. Intramedullary fluid in-wash effects as well as resulting electrolytic disorders could not be proven. For abrasive waterjet osteotomies with 3 component jet a relevant risk of thrombembolic effects could be shown. This knowledge has also to be considered for abdominal and neurosurgical applications in the future. Due to the usage of an abrasive suspension this risk can fully be avoided.

[Reabsorption syndrome after transurethral resection (TUR) of the prostate: review of physiologic, diagnostic, and therapeutic features]

In spite of the development of non-invasive strategies, surgical treatment of the prostate (TURP) and, mostly transurethral resection, is the most effective choice for patients suffering from benign prostatic hyperplasia who do not respond properly to pharmacological treatment. Absorption of hypotonic fluids used during TURP may cause hemodynamic and central nervous system disturbances. These symptoms, both taken separately or as a whole, are best known as "Transurethral prostatic resection syndrome" or "TURP syndrome". The original description of this syndrome dates from half a century ago; however, a number of items regarding its physiopathology and treatment remain unclear. We present a review of this pathological entity, compiling diagnostic and therapeutical approaches.