Detection of fluid volume absorption by end-tidal alcohol monitoring in patients undergoing endoscopic renal pelvic surgery.

摘要

STUDY OBJECTIVE: To determine the risk of relevant fluid absorption (calculated volume above 500 ml) during endoscopic procedures of the renal pelvis. DESIGN: Prospective clinical investigation with implementation of statistical process control tools (SPC). SETTING: Nonuniversity teaching hospital. PATIENTS: 62 consecutive ASA physical status I and II patients scheduled for endoscopic renal pelvic surgery with general anesthesia. INTERVENTIONS: Intraoperative measurement of breath alcohol for detection of fluid absorption. Irrigation fluid (0.9% saline) with 1% alcohol for tracing the irrigation fluid. MEASUREMENTS AND MAIN RESULTS: Calculation of the amount of fluid absorbed using breath alcohol values. Process variability (numbers of patients with relevant fluid absorption) defined by SPC. The prevalence of fluid absorption in endoscopic renal pelvic surgery was 6%. Peak fluid absorption during a vascular route was detected by the monitoring. Monitoring was easily introduced into routine clinical practice. No relevant side effects due to the monitoring were seen in patients with relevant fluid absorption. There was no mortality, but two patients with detected severe fluid overload were admitted to the intensive care unit for treatment. CONCLUSION: Breath alcohol levels during general anesthesia for endoscopic renal pelvic surgery were technically simple to measure. Our results show the predictive value of alcohol monitoring, which has been previously demonstrated only for transurethral prostatectomy. The prevalence of relevant fluid absorption was 6% compared to 13% during transurethral resection of the prostate.