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Prophylaxis versus treatment against transurethral resection of prostate syndrome: The role of hypertonic saline

 Department of Anesthesia, Faculty of Medicine, Cairo University, Giza, Egypt

Correspondence Address:
Hany A. Shehab,
45, Ahmed Maher St., Giza, Egypt

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aer.AER_148_19

Background: This study aimed at investigating the usage and effects of prophylactic hypertonic saline (HS) to prevent the occurrence of transurethral resection of the prostate (TURP) syndrome. Materials and Methods: Sixty American Society of Anesthesiologists physical status classes I–III candidates for TURP using the monopolar resectoscope were randomized into three groups 20 patients each. Group A received 4 HS 3%; Group B received 2 HS 3%; and Group C received 6 normal saline. Hemodynamics, vasopressors need, electrolytes (sodium, potassium, and chloride), osmolality, and arterial-blood gas (ABG) were recorded. The incidence of transurethral resection syndrome, intensive care unit (ICU) admission, postoperative ventilation, hospital stay as well as any adverse events were noted. Results: Hypernatremia was detected in six patients (P = 0.002) of Group A only, while hyponatremia occurred in five patients (P = 0.009) of Group C alone. Serum sodium in Group C showed a significant decrease starting from T2 (1 h postresection) till Tp3 (48 h postoperative). In Group C, five patients experienced hypotension and bradycardia; hypertensive episodes also occurred in five patients and a hypervolemic state was noted in seven patients. TURP syndrome was confirmed in only five patients, all in Group C (P = 0.009). Postoperative ICU admission was needed for seven patients of C Group, five of which required assisted ventilation. The overall hospital stay was longer for Group C patients. Conclusion: Prophylactic administration of HS during TURP is superior to conventional treatment of an occurred TURP syndrome. Low dose (2 HS 3%) is effective without adverse effects or risk of contrary hypernatremia.

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