Comparison of hemodynamic profiles in transurethral resection of prostate vs transurethral resection of urinary bladder tumors during spinal anesthesia: a bioimpedance study.
OBJECTIVE
Transurethral resection of prostate (TURP) is more frequently associated with perioperative fluid and electrolyte disturbances than transurethral resection of bladder tumors (TURT) because of irrigating fluid absorption. Because fluid overload may cause hypertension, we compared the patients' intraoperative hemodynamic profiles (including the incidence of hypertension) during TURP vs TURT, both performed during spinal anesthesia, by using the bioimpedance method.


METHODS
Prospective single-blind study.


METHODS
University hospital.


METHODS
80 (40 in each group) men, ASA physical status I and II.


METHODS
Patients underwent TURP or TURT surgery with spinal anesthesia.


METHODS
Mean arterial pressure, heart rate, cardiac index, and systemic vascular resistance were compared between the 2 groups. A mean arterial pressure greater than 30% from the baseline value was considered as hypertension. Plasma sodium was measured preoperatively, intraoperatively, and postoperatively.


RESULTS
Transurethral resection of prostate patients received more irrigating fluid (7900 +/- 2310 vs 5650 +/- 21560, P < 0.05) and had a higher calculated volume of fluid absorbed: 638 +/- 60 vs 303 +/- 40 mL for the TURT patients (P < 0.05). Mean arterial pressures were higher with TURP, 30 minutes after the onset of surgery and at the end of the procedure (111 +/- 15 vs 100 +/- 10 and 109 +/- 14 vs 99 +/- 14 mmHg, respectively; P < 0.05). However, there was no hypertension in either group. There were no differences in hemodynamic measurements of hyponatremic vs normonatremic patients. Plasma sodium decreased postoperatively more in the TURP group (140.4 +/- 2.6 mEq/L baseline to 134.1 +/- 3.5 mEq/L, P < 0.05) and was lower postoperatively in the TURP group compared with TURT (134.1 +/- 3.5 vs 137.2 +/- 2.9 mEq/L, P = 0.04).


CONCLUSIONS
Although more irrigating fluid was absorbed in the TURP group, there were no episodes of hypertension in either group.
Ezri
Tiberiu
T
Department of Anesthesia, Wolfson Medical Center, affiliated to Sackler Medical School, Tel Aviv University, 58100 Israel.
Issa
Nidal
N
Zabeeda
Deeb
D
Medalion
Benjamin
B
Tsivian
Alexander
A
Zimlichman
Reuven
R
Szmuk
Peter
P
Evron
Shmuel
S
D000368:Aged; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D001794:Blood Pressure; D002302:Cardiac Output; D017097:Electric Impedance; D006801:Humans; D007010:Hyponatremia / Q000209:etiology; D008297:Male; D016037:Single-Blind Method; D007507:Therapeutic Irrigation; D020728:Transurethral Resection of Prostate; D001749:Urinary Bladder Neoplasms / Q000601:surgery*