Incidence of perioperative myocardial ischemia in TURP patients

Rapid-Onset Acute Respiratory Distress Syndrome (ARDS) in a Patient Undergoing Metastatic Liver Resection: A Case Report and Review of the Literature

Metastatic liver resection following cytoreductive chemotherapy is an accepted treatment for oligometastatic tumor diseases. Although pulmonary complications are frequently reported in patients undergoing liver surgery including liver transplantation, life-threatening acute respiratory failures in the absence of aspiration, embolism, transfusion-related acute lung injury (TRALI), pulmonary infection, or an obvious source of systemic sepsis are rare. We performed an extensive clinical review of a patient undergoing metastatic liver resection who had a clinical course compatible to an acute respiratory distress syndrome (ARDS) without an obvious cause except for the surgical procedure and multiple preoperative chemotherapies. We hypothesize that either the surgical procedure mediated by cytokines and tumor necrosis factor or possible toxic effects of oxygen applied during general anesthesia were associated with life-threatening respiratory failure in the patient. Discrete and subclinical inflammated alveoli (probably due to multiple preoperative chemotherapies with substances at potential risk for interstitial pneumonitis as well as chest radiation) might therefore be considered as risk factors.

[Anaesthesia and prostate surgery]

OBJECTIVES

To review the current data about anaesthetic management in prostate surgery with special regards on analysis and prevention of specific risks, appropriate anaesthetic procedure keeping with surgery and patient, recognition and treatment of adverse events.

DATA SOURCES AND EXTRACTION

The Pubmed database was searched for articles (1990-2004) combined with references analysis of major articles on the field.

DATA SYNTHESIS

It is strongly recommended to settle germfree urine in the preoperative period. The thromboembolic risk of radical retropubic prostatectomy for cancer parallels lower abdomen oncologic surgery and is prolonged. Preoperative evaluation of cardiovascular, respiratory, neurological and metabolic comorbidity is a source of prognostic information and an essential tool in the management of elderly patients with prostate disease. Extreme patient positioning applied in prostate surgery induces haemodynamic and respiratory changes and are associated with severe muscular and nervous injuries. The laparoscopic access for radical prostatectomy is a growing alternative to the open surgical procedure. Acute normovolaemic haemodilution is a consistent and cost-effective blood conservation strategy in reducing allogenic blood transfusion for radical retropubic prostatectomy. Whether open transvesical or transurethral prostatectomy for treatment of benign hypertrophy depends on the size of the gland: transurethral resection is safe up to 80 g. Intrathecal anaesthesia with a T9 cephalad spread of sensory block, produces adequate conditions for transurethral prostatectomy and allows a rapid diagnosis of irrigating fluid absorption syndrome. In spite of recommended preoperative antibiotic prophylaxis, bacteriemias are frequent during transurethral prostate resection.

[Reabsorption syndrome after transurethral resection (TUR) of the prostate: review of physiologic, diagnostic, and therapeutic features]

In spite of the development of non-invasive strategies, surgical treatment of the prostate (TURP) and, mostly transurethral resection, is the most effective choice for patients suffering from benign prostatic hyperplasia who do not respond properly to pharmacological treatment. Absorption of hypotonic fluids used during TURP may cause hemodynamic and central nervous system disturbances. These symptoms, both taken separately or as a whole, are best known as "Transurethral prostatic resection syndrome" or "TURP syndrome". The original description of this syndrome dates from half a century ago; however, a number of items regarding its physiopathology and treatment remain unclear. We present a review of this pathological entity, compiling diagnostic and therapeutical approaches.

Detection of fluid volume absorption by end-tidal alcohol monitoring in patients undergoing endoscopic renal pelvic surgery

STUDY OBJECTIVE

To determine the risk of relevant fluid absorption (calculated volume above 500 ml) during endoscopic procedures of the renal pelvis.

DESIGN

Prospective clinical investigation with implementation of statistical process control tools (SPC).

SETTING

Nonuniversity teaching hospital.

PATIENTS

62 consecutive ASA physical status I and II patients scheduled for endoscopic renal pelvic surgery with general anesthesia.

INTERVENTIONS

Intraoperative measurement of breath alcohol for detection of fluid absorption. Irrigation fluid (0.9% saline) with 1% alcohol for tracing the irrigation fluid.

MEASUREMENTS AND MAIN RESULTS

Calculation of the amount of fluid absorbed using breath alcohol values. Process variability (numbers of patients with relevant fluid absorption) defined by SPC. The prevalence of fluid absorption in endoscopic renal pelvic surgery was 6%. Peak fluid absorption during a vascular route was detected by the monitoring. Monitoring was easily introduced into routine clinical practice. No relevant side effects due to the monitoring were seen in patients with relevant fluid absorption. There was no mortality, but two patients with detected severe fluid overload were admitted to the intensive care unit for treatment.

CONCLUSION

Breath alcohol levels during general anesthesia for endoscopic renal pelvic surgery were technically simple to measure. Our results show the predictive value of alcohol monitoring, which has been previously demonstrated only for transurethral prostatectomy. The prevalence of relevant fluid absorption was 6% compared to 13% during transurethral resection of the prostate.