From the Journal archives: Complications of transurethral prostatic surgery: Back to the future?

摘要

Author: John Desmond MBBS FRCP(C) Citation: Complications of transurethral prostatic surgery. Can Anaesth Soc J 1970; 17: 25-36. Purpose: To review complications of transurethral resection of the prostate (TURP) as they pertain to anesthesiologists. Principal findings: In this article published in January 1970 in the Canadian Anaesthetists' Society Journal, now the Canadian Journal of Anesthesia (the Journal), the author reviews complications relating to TURP, including age group, cardiovascular status, plasminogen activation, bacteremia, hemorrhage, too-light general anesthesia, perforation of the bladder, inadvertently high spinal anesthetic, the danger of using vasopressors, and burns. Complications involving the endocrine system, erection, adductor spasm, explosions, and hypothermia are also mentioned. Furthermore, there is a detailed discussion regarding the composition of the irrigation solution and the effects of its intravenous absorption on the cardiovascular system and on serum osmolality and natremia. The results of slow absorption of irrigation fluid at the prostatic level combined with good left-ventricular function are associated with slight dilutional hyponatremia (≤ 10 mEq·L-1) and a good outcome. Rapid absorption of irrigation fluid and/or poor left-ventricular function in the context of possible acute blood loss, hypotension following spinal anesthesia, or myocardial depression with general anesthesia can lead to a marked drop in osmolality and more severe dilutional hyponatremia. This may lead to cerebral edema, pulmonary edema, heart failure, and cardiovascular collapse. In a series of 72 randomly chosen patients at the author's institution, 18 patients experienced a reduction in serum sodium of 10 mEq·L-1; eight patients experienced a reduction of 20 mEq·L-1, and two patients experienced a decrease in both osmolality and natremia, with both developing cerebral and pulmonary edema. Conclusions: With an understanding of the possible complications and physiological implications of TURP, anesthesiologist caring for such patients may help reduce adverse outcomes or decrease their impact with proper management. In the late 1960s, mortality at the author's institution was reduced from 1.5-0.4% in three years.