1 / 17

Complications of TURP

Complications of TURP. 1. Case presentation 2. TURP syndrome 3. Prevention and treatment Ri 陳昭勳. Brief History. 陳 X 傑 63 y/o male Symptoms of urinary frequency and urgency OPD follow-up and controlled by Hytrin. Past History.

yaron
Télécharger la présentation

Complications of TURP

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Complications of TURP • 1. Case presentation • 2. TURP syndrome • 3. Prevention and treatment Ri 陳昭勳

  2. Brief History • 陳X傑 63y/o male • Symptoms of urinary frequency and urgency • OPD follow-up and controlled by Hytrin

  3. Past History • Coronary artery disease s/p stenting controlled by Aspirin • Hypertension controlled by Norvasc • ASA Class III

  4. Incidence of systemic dz in TURP patients Disease Incidence % Cardiac disease 67 Cardiovascular 50 COPD 29 DM 8

  5. Brief History • 2 weeks ago difficulty in urination • Foley catheterizations several times • Cystostomy on 91-2-18 DC Tapal • Admission for TURP on 91-2-25

  6. 麻醉過程 • Please see 實物投影機

  7. Irrigation Solution • Ideal: isotonic, electrically inert, nontoxic, transparent, easy to sterilize,inexpensive • Traditional: distilled water • Modern: Glycine (1.2% and 1.5) Mannitol ( 3%) Urea ( 1%)

  8. Definition of TURP syndrome • Following complications have been reported: hypervolemia, hyponatremia, water intoxication, pulmonary edema, hemolysis, caogulopathy, bladder perforation

  9. TURP syndrome: a problem of Volume and Solute • Intravascular volume: volume expansion and volume loss • Plasma solute: hyponatremia hypoosmolality hyperglycinemia Plasma osmolality=2xNa+Glu/18+BUN/2.8

  10. Hyponatremia • Mechanism for hyponatremia in TURP • Na is essential for cerebral and cardiac function • <120 meq/L cardiovascular depression <115meq/L bradycardia,ECG change <100meq/L generalized seizure • Average fall in Na 3.65-10 meq/L • Incidence 7%-26%

  11. Hypoosmolality • Derangement of CNS function due to cerebral edema • Clinical signs: decerebrate posture, positive Babinski sign, low-voltage EEG, comatose

  12. Hemolysis • 30-70% of patients, who use water as irrigation solution • Clinical signs: chills, clammy skin, tight chest, bronchospasm • Oxygen carrying capacity decrease Free hemoglobin increase Hyperkalemia

  13. Bladder Perforation • Caused by instrumentation, overdistension or explosion of hydrogen • Most bladder perforation is retroperitoneal • Clinical signs: return of irrigation solution decrease, abdominal distension

  14. Prevention of TURP syndrome • Surgical technique • 術前矯正electrolyte and fluid imbalance • Special attention to cardiac p’t • Height of irrigation solution bag • Duration of surgery

  15. Treatment of TURP syndrome • Terminate surgery • Administer Lasix • Hypertonic saline (3-5%) for hyponatremia • Intubation for pulmonary edema • Diazepam for seizure

  16. References • Transurethral Resection of the Prostate Syndrome: A Review of the Pathophysiology and Management Anesthesia and Analgesia Feb ’97 438 • Anesthesia for Renal and Genito-Urologic surgery • Complications of Urologic Surgery

  17. Estimation of Fluid Absorption • Serum Sodium Dilution [(Pre-Op Na)/ (Post-op Na) –1] x ECF • Breath-alcohol level • Patient’s weight gain

More Related