How to master absorption during transurethral resection of the prostate: basic measures guided by the ethanol method

Hultén, Jan O.

doi:10.1046/j.1464-410x.2002.02882.x

Cited by 8 publications

(3 citation statements)

References 14 publications

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“…There are many monitoring methods for uid absorption during TURP, such as adding ethanol to irrigation uid [22], monitoring hemodynamics [23], and weighing [24], but almost all of them are currently not satisfactory. The pulse index continuous cardiac output (PICCO) technique is the gold standard for bedside quantitative measurements of EVLW.…”

Section: Discussionmentioning

confidence: 99%

Application of Lung Ultrasound in Monitoring Fluid Overload During Transurethral Resection of the Prostate: A Feasibility Study

Zhang,

Huang,

Zhang

et al. 2023

Preprint

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Background Fluid absorption is common in patients undergoing transurethral prostate resections. We aimed to explore the feasibility of using lung ultrasound to monitor fluid overload during and after surgery by detecting extravascular lung water. Methods We conducted a single-center prospective observational study of patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate (TURP) under general anesthesia between December 2020 and August 2021. Lung ultrasound was performed before the operation (T1), 1 h after the surgery started (10 min before the end of the operation if the operation time was < 1 h) (T2), and before leaving the post-anesthesia care unit (PACU, T3) to assess the changes in extravascular lung water. Lung ultrasound scores ≥ 20 were defined as significantly increased extravascular lung water (EVLW). The primary outcome was the incidence of increased EVLW at T3. The secondary outcomes included delayed recovery, postoperative shivering, hypoxemia, time to extubation, time in the PACU, and length of postoperative hospital stay. Results All patients had normal extravascular lung water before surgery, and 6.9% and 35.5% of patients had increased EVLW at T2 and T3, respectively. Increased extravascular lung water prolonged extubation and recovery times. However, postoperative shivering, hypoxemia, and the length of postoperative hospital stay were not significantly affected. Conclusions Lung ultrasound is a reliable noninvasive bedside tool for monitoring fluid absorption during TURP under general anesthesia.

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Section: Discussionmentioning

confidence: 99%

Application of Lung Ultrasound in Monitoring Fluid Overload During Transurethral Resection of the Prostate: A Feasibility Study

Zhang,

Huang,

Zhang

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…[11] Hahn et al . [3] studied the potential benefits of using 1% ethanol as the tracer of fluid absorption along with glycine as the irrigating fluid during TURP.…”

Section: Discussionmentioning

confidence: 99%

Does an alcolmeter in the hands of an anesthesiologist make TURP safer? - Results from a case-control study

et al. 2013

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Background:This hospital-based, prospective, case-controlled study was carried out to monitor fluid absorption during transurethral resection of the prostrate (TURP) by marking the irrigating fluid with ethanol for signs of TURP syndrome. Addition of ethanol allows early detection and prevention of full blown TURP syndrome as also the volume of fluid absorbed can be measured.Subjects and Methods:Patients were divided into two groups of 50 each, taking males undergoing TURP belonging to ASA (American Society of Anesthesiologists) I and II. Group 1 received irrigation with 1.5% glycine alone and group 2 received irrigation with 1.5% glycine along with ethanol during TURP. The primary outcome measure was the detection of TURP syndrome using end expiratory ethanol levels and comparing with serum electrolytes and clinical manifestations. The secondary outcome measures, the hemodynamic parameters such as heart rate, systolic and diastolic pressures, and oxygen saturation were recorded during the intraoperative period after spinal anesthesia and then postoperatively till the end of the first hour in the recovery room.Statistical Analysis:Chi-square test, Student's t-test and Pearson's correlation coefficient ‘r’.Results:Mean resection time in the ethanol positive patients (36.36 min) was significantly higher than that in the ethanol negative patients (22.08 min) (P < 0.01). The estimated fluid absorbed was statistically significant in 45 minutes of resection in three patients with positive ethanol readings (P < 0.05). Resection was temporally stopped in 16 patients (32%) and permanently in 1 patient (2%), whose resection time reached 60 min. A positive correlation was found between total fall in serum sodium and maximum expiratory ethanol concentration. There was a significant difference in the heart rate between the two groups in the 40th minute (P < 0.05).Conclusion:Ethanol is a noninvasive, easy-to-use marker in irrigating fluid for assessing fluid absorption. It forewarns to take corrective measures earlier than both fall in sodium and manifestations of TURP syndrome, allowing successful completion of TURP.

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“…However, the introduction of ethanol-containing irrigating fluids, with which fluid absorption can be measured by expired-breath tests [26,27], opened up the possibility of a statistical approach to the symptomatology when progressively more glycine 1.5% is absorbed [28]. …”

Section: Clinical Studiesmentioning

confidence: 99%

Glycine 1.5% for Irrigation Should Be Abandoned

Hahn

2013

Urol Int

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Background: Glycine 1.5% has long maintained a dominating role as an irrigating solution for monopolar transurethral resection of the prostate (TURP), as well as for certain other transurethral procedures. Materials and Methods: This review summarizes the findings ofsystematic experimental and clinical studiesin which glycine 1.5% for irrigation was infused/absorbed and the outcome compared to at least one other irrigating fluid, including the isotonic saline used for bipolar TURP. Results: There were 11 studies in animals, 3 in volunteers and 6 in patients undergoing TURP. With only one exception, which is probably due to low power, these studies either show a poorer outcome after administration or absorption of glycine solution or else that glycine 2.2% is more toxic than glycine 1.5%. The poorer outcomes consisted of more tissue damage or higher mortality (animals) or more symptoms (volunteers and patients). Conclusion: The safety of monopolar TURP would be improved by replacing glycine 1.5% with some other electrolyte-free fluid. The author argues that glycine 1.5% should be abandoned completely.

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How to master absorption during transurethral resection of the prostate: basic measures guided by the ethanol method

Cited by 8 publications

References 14 publications

Application of Lung Ultrasound in Monitoring Fluid Overload During Transurethral Resection of the Prostate: A Feasibility Study

Application of Lung Ultrasound in Monitoring Fluid Overload During Transurethral Resection of the Prostate: A Feasibility Study

Does an alcolmeter in the hands of an anesthesiologist make TURP safer? - Results from a case-control study

Glycine 1.5% for Irrigation Should Be Abandoned

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