[Distribution of irrigating fluid in intracellular and extracellular spaces during transurethral prostatectomy II--TUR syndrome and hyponatremia].
Thirty four patients undergoing transurethral resection of the prostate (TURP) under spinal anesthesia were assigned to a TUR syndrome (TURS) group (n = 7) or an asymptomatic (ASP) group (n = 27) depending on the clinical manifestations of the TUR syndrome. Blood loss and distribution of absorbed irrigating fluid (3% sorbitol-Uromatic S, 170 mOsm.kgH2O-1, Baxter) were computed together with serum osmolality, blood urea nitrogen and hematocrit. Postoperative serum sodium concentration and hematocrit were significantly lower in the TURS group than in the ASP group (124 +/- 8.7 vs. 133.9 +/- 5.9 mOsm.l-1 and 26. 8 +/- 4.2 vs. 35.0 +/- 4.6%, respectively). Postoperative serum osmotic pressure did not differ between the groups despite the difference in sodium concentration because 3% sorbitol could contribute to osmoles in the serum. The volume of irrigating fluid absorbed and its distribution into the intracellular space (delta ICF) did not differ between the groups. However, blood loss was significantly greater in the TURS group than in the ASP group (1457 +/- 434 ml vs. 173 +/- 450 ml, P < 0.01), and consequently extracellular fluid (ECF) volume was significantly reduced in the TURS group (-354 +/- 1201 ml vs. 802 +/- 1302 ml, P < 0.05). Thus, massive blood loss and reduced ECFs rather than dilutional hyponatremia, are thought to contribute to clinical manifestation of the TUR syndrome.
Miyao
H
H
Department of Anesthesiology, Saitama Medical Center, Saitama Medical School, Kawagoe.
Tanaka
K
K
Kotake
Y
Y
Kawazoe
T
T
Fujioka
T
T
D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal; D016063:Blood Loss, Surgical; D005110:Extracellular Space / Q000378:metabolism*; D006801:Humans; D007010:Hyponatremia / Q000150:complications*; D007022:Hypotension / Q000209:etiology*; D007424:Intracellular Fluid / Q000378:metabolism*; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000209:etiology*; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D013577:Syndrome; D007507:Therapeutic Irrigation / Q000009:adverse effects*