Document Detail

Haemodynamic evidence for cardiac stress during transurethral prostatectomy.
MedLine Citation:
PMID:  1571637     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare haemodynamic performance during transurethral prostatectomy and non-endoscopic control procedures similar in duration and surgical trauma. DESIGN: Controlled comparative study. SETTING: London teaching hospital. PATIENTS: 33 men aged 50-85 years in American Society of Anesthesiologists risk groups I and II undergoing transurethral prostatectomy (20), herniorrhaphy (eight), or testicular exploration (five). MAIN OUTCOME MEASURES: Percentage change from baseline in mean arterial pressure, heart rate, Doppler indices of stroke volume and cardiac output, and index of systemic vascular resistance, and change from baseline in core temperature. RESULTS: In the control group mean arterial pressure fell to 11% (95% confidence interval -17% to -5%) below baseline at two minutes into surgery and remained below baseline; there were no other overall changes in haemodynamic variables and the core temperature was stable. During transurethral prostatectomy mean arterial pressure increased by 16% (5% to 27%) at the two minute recording and remained raised throughout. Bradycardia reached -7% (-14% to 1%) by the end of the procedure. Doppler indices of stroke volume fell progressively to 15% (-24% to -6%) below baseline at the end of the procedure, and the index of cardiac output fell to 21% (-32% to -10%) below baseline by the end of the procedure. The index of systemic vascular resistance was increased by 28% (17% to 38%) at two minutes, and by 46.8% (28% to 66%) at the end of the procedure. Core temperature fell by a mean of 0.8 (-1.0 to -0.6) degrees C. Significant differences existed between the two groups in summary measures of mean arterial pressure (p less than 0.05), Doppler indices of stroke volume (p less than 0.005) and cardiac output (p less than 0.005), index of systemic vascular resistance (p less than 0.0005), and core temperature (p less than 0.0001). CONCLUSIONS: Important haemodynamic disturbances were identified during routine apparently uneventful transurethral prostatectomy but not during control procedures. These responses may be related to the rapid central cooling observed during transurethral prostatectomy and require further study.
J W Evans; M Singer; C R Chapple; N Macartney; J M Walker; E J Milroy
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  BMJ (Clinical research ed.)     Volume:  304     ISSN:  0959-8138     ISO Abbreviation:  BMJ     Publication Date:  1992 Mar 
Date Detail:
Created Date:  1992-06-01     Completed Date:  1992-06-01     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8900488     Medline TA:  BMJ     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  666-71     Citation Subset:  AIM; IM    
Department of Urology, Middlesex Hospital, London.
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MeSH Terms
Aged, 80 and over
Blood Pressure / physiology
Body Temperature / physiology
Cardiac Output / physiology
Heart Rate / physiology
Hemodynamics / physiology*
Middle Aged
Prostatectomy / adverse effects*
Stress, Physiological / etiology*
Stroke Volume / physiology
Vascular Resistance / physiology
Comment In:
BMJ. 1992 May 9;304(6836):1247   [PMID:  1472249 ]
BMJ. 1992 May 9;304(6836):1247   [PMID:  1515811 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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