Hypothermic prostatic resection

Surgical hypothermia

Induced hypothermia is an interesting and useful adjunct to therapy in many areas of surgery and medicine. To paraphrase Professor Swan (1973), clinical hypothermia 'has a past and some promise for the future'.

The effect of warm irrigation on blood loss during transurethral prostatectomy under spinal anaesthesia

In this prospective trial a study was made of the effect of warm irrigation on blood loss during transurethral prostatectomy (TURP). A control group of 21 patients in whom irrigating fluid at operating room temperature (mean 21.5 degrees C) had been used was compared with a statistically comparable group of 19 patients in whom warm irrigating fluid (mean 33.1 degrees C) had been used. Blood loss in ml, in ml/g of tissue resected and in ml/min of resection time was not increased by the use of warm rather than room temperature irrigation. It was found that warm irrigation decreased heat loss and shivering in the patient during TURP and led to improved comfort both for patient and operator. The method of heating the irrigation bags was safe and economical.

Determination of blood loss during transurethral prostatic resection. Modification of a method

Following transurethral prostatic resection in 69 patients, the haemoglobin content of the irrigation fluid was determined first after manual stirring, then after mechanical stirring, and finally after mechanical stirring plus chemical reduction of the surface tension. The measured blood loss, based on haemoglobin content of the fluid, was significantly greater after the third procedure than when only manual stirring was used. To establish the clinical consequences of this observation, measurements of blood loss were based on sets of ten determinations of haemoglobin in irrigation fluid in two groups of operations. In one group the postoperative stirring of the fluid was manual and the results were scattered within a wide range, indicating unreliability of blood loss determinations based on a single sample. In the other group, mechanical and chemical preventive measures were used against formation of blood clots and the measurements showed little variation. It is concluded that complete lysis of the blood in irrigation fluid is necessary for reliable calculation of blood loss. An adequate method to achieve this objective is indicated.

The effect of local hypothermia on blood loss during transurethral resection of the prostate

A prospective trial to investigate the effect of using cold irrigating solution during transurethral resection of the prostate was carried out. A control group of 44 patients was resected using irrigant at room temperature, and a trial group of 49 cases was resected using irrigant cooled to 2 degrees C. Blood loss during surgery was measured to see whether the cold irrigating solution had any effect on this loss. There was a small reduction in blood loss in the cold group, but this reduction was not statistically significant (0.5 greater than P greater than 0.3).

The use of cooled irrigating fluid for transurethral prostatic resection

Forty patients selected for transurethral prostatic resection (TUR) were randomly allocated to one of 2 groups. Irrigating fluid used in the first group of 20 patients was cooled to a constant 8 degrees C; in the second group fluid at ambient temperature was used. Measurements were made of the volume of irrigating fluid used and haemoglobin loss during and after operation; the weight of resected tissue and its histological appearance were also studied. The core temperature of each patient was monitored throughout the operation. Significantly less irrigating fluid was used in the group receiving cooled fluid. Although per-operative and post-operative haemoglobin loss was also markedly reduced in this group, the difference failed to achieve statistical significance. The clarity of the operative field was considerably improved by the use of cooled fluid.

Body temperature changes during transurethral prostatectomy

A prospective trial was made to investigate the effects of cold irrigating solutions on body temperatures during transurethral resection of the prostate. In a control group of 45 cases, when the irrigating fluids had a mean temperature of 21.9 degree C, there was a significant fall in body temperature from 36 +/- 0.6 degree C to 34.9 +/- 0.7 degree C. In test group A to 48 cases, when the irrigating fluids had a mean temperature of 4.96 degree C, there was a significant fall in body temperature from 36.1 +/- 0.6 degree C to 34.8 +/- 0.9 degree C. In test group B (five cases) when the irrigating fluids had a mean temperature of 10.2 degree C there was a significant fall in body temperature from 36.0 +/- 0.4 to 34.6 +/- 0.8. Comparative analyses between the control group and test group A did not show significant differences in the degrees of cooling in the two groups.