Document Detail


Irrigation fluid absorption during transurethral resection of the prostate: spinal vs. general anaesthesia.
MedLine Citation:
PMID:  10225081     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The absorption of irrigation fluid during transurethral resection of the prostate (TURP) is determined primarily by hydrostatic pressure in the bladder and prostatic venous pressure. In comparison to spontaneously breathing patients, patients undergoing mechanical ventilation with positive pressure have a raised central venous pressure and a reduced venous return, both of which can influence intravascular absorption. The purpose of the prospective study was to compare the effects of general (GA) and spinal anaesthetic (SA) techniques on the perioperative absorption of irrigating fluid in patients undergoing TURP. METHODS: Forty patients undergoing TURP were randomised and assigned either to group GA or SA. Irrigating fluid absorption was traced by adding 1.5% (w/v) ethanol to the irrigating fluid. Perioperative blood ethanol concentration (BEC), haemoglobin concentration, haematocrit, serum sodium concentration and central venous pressure (CVP) were measured at 10-min intervals during TURP and at 30-min intervals while patients were recovering. Absorption routes were indexed by the BEC and changes in serum sodium concentrations. Where the BEC was greater than 0.05 mg.mL-1, absorption of irrigating fluid was assumed. For assessing the volume of irrigating fluid absorbed, the maximum BEC, the absorption rate, the area under the BEC curve (AUC), and the volumes calculated according to the Hahn nomogram (Volin) for each patient were taken into consideration. RESULTS: There were 15 cases of irrigating fluid absorption in patients receiving GA (75%), and 11 in those receiving SA (55%). CVP was significantly lower in spontaneously breathing patients with SA as compared to those with GA (P < 0.05). In patients with irrigating fluid absorption the maximum BEC (P < 0.02), as well as the rate of irrigant fluid absorption (P < 0.01), were significantly higher amongst patients receiving SA. In this group, the calculated area under the curve and the absorbed fluid volumes determined with the nomogram were significantly increased (P < 0.05). CONCLUSION: The absorption of irrigation fluid during the TURP is significantly more marked amongst spontaneously breathing patients with regional anaesthesia in comparison to patients undergoing general anaesthesia with positive pressure ventilation. The markedly lower central venous pressure before the start of irrigation should be considered as a possible cause of this effect.
Authors:
H Gehring; W Nahm; J Baerwald; P Fornara; A Schneeweiss; A Roth-Isigkeit; P Schmucker
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  43     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-06-18     Completed Date:  1999-06-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  458-63     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology, Medical University, Luebeck, Germany.
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MeSH Terms
Descriptor/Qualifier:
Absorption
Aged
Anesthesia, General*
Anesthesia, Spinal*
Area Under Curve
Central Venous Pressure / physiology
Ethanol / blood,  diagnostic use
Follow-Up Studies
Hematocrit
Hemoglobins / analysis
Humans
Hydrostatic Pressure
Indicators and Reagents
Irrigation
Male
Positive-Pressure Respiration
Prospective Studies
Prostate / blood supply
Prostatectomy*
Respiration
Sodium / blood
Sorbitol / pharmacokinetics*
Urinary Bladder / metabolism
Venous Pressure / physiology
Chemical
Reg. No./Substance:
0/Hemoglobins; 0/Indicators and Reagents; 50-70-4/Sorbitol; 64-17-5/Ethanol; 7440-23-5/Sodium

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