title: The TURP syndrome: importance of expiratory ethanol measurement and high serum levels of glycine.
abstract: OBJECTIVE
  In a prospective study it was our intention to evaluate the reliability and the predictive value of expiratory ethanol for the early detection of the occurrence of TURP syndrome and emphasize the role of the serum levels of glycine in clinical manifestation.
  
  
  METHODS
  We studied 30 patients scheduled for elective traditional transuretral resection of the prostate performed with subarachnoid anesthesia. Serum sodium and glycine concentrations, serum osmolality and end-expiratory ethanol levels were monitored at scheduled intervals. Continuous heart rate and blood pressure monitoring was performed during the perioperative period in the operativing room and, later, in the recovery room. Occurrence of cardiocirculatory, respiratory and neurologic symptoms were recorded. Statistics included Bonferroni's t-test and Fisher's exact test. A decision level plot for end-expiratory ethanol level was performed for the choice of predictivity criterion.
  
  
  RESULTS
  In our population we identified three groups of patients: Group I (15 patients) in which no symptom was recorded; Group II (6 patients) in which non-specific anesthesia-related symptoms occurred; Group III (9 patients) in which TURP syndrome of various degree of severity was observed. In this group of patients changes in serum sodium and glycine concentrations, serum osmolality and end-expiratory ethanol levels were significantly different compared with the other two groups. In regard to end-expiratory ethanol levels, we identified a cut-off point at 0.05 mg/ml. In Group III two patients developed transient blindness. These patients had the highest serum glycine concentrations (> 4000 mumol/ml). Mortality was nil.
  
  
  CONCLUSIONS
  Our data show the reliability and accuracy of end-expiratory ethanol levels as a predictive test of the occurrence of TURP syndrome. Further, we emphasize the role of serum glycine concentration in the occurrence of neurologic symptoms related to the transurethral resection of the prostate.
authors.affiliation: Institute of Anesthesiology and Intensive Care, University of Verona, Verona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bartoloni
authors.forename: L
authors.initials: L
authors.lastname: Gottin
authors.forename: V
authors.initials: V
authors.lastname: Ficarra
authors.forename: C
authors.initials: C
authors.lastname: Capotosto
authors.forename: G
authors.initials: G
authors.lastname: Malossini
authors.forename: C
authors.initials: C
authors.lastname: Tallarigo
authors.forename: G
authors.initials: G
authors.lastname: Finco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001944:Breath Tests; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism; D000431:Ethanol / Q000032:analysis / Q000378:metabolism*; D005998:Glycine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012119:Respiration; D013577:Syndrome; D020728:Transurethral Resection of Prostate / Q000009:adverse effects*
chemical_list: D000431:Ethanol; D005998:Glycine