Effects of hypertonic saline preloading in sub arachnoid blockade for transurethral resection of prostate - A comparative study

Abstract

Introduction:Now a day's most of the urological operations including transurethral resection of prostate (TURP) are performed under sub-arachnoid block (SAB). SAB is gaining increase popularity and replacing general anaesthesia gradually. Advantages are virtual avoidance of risks of general anaesthesia, for example, gastric aspiration and difficult tracheal intubation and also TURP syndrome can not be diagnosed early, whereas SAB is very useful to diagnose early and potentially prevent the above mentioned problems. However, hypotension after SAB results from functional sympathetic devervation, not only of the arterial and arteriolar

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

“…Despite that hemodynamic effects induced by spinal anesthesia are usually well tolerated in young healthy patients, the prevention of hypotension is commonly achieved using fluid preloading for older ones. [ 15 ] Again, the administration of excess free water is to be avoided in patients with cardiovascular restrictions. [ 16 ] Isotonic crystalloids, the fluids commonly used to expand the plasma volume, may be ineffective as about 75% of the solution diffuses extravascularly into the interstitial space within a short time.…”

“…[ 16 ] Isotonic crystalloids, the fluids commonly used to expand the plasma volume, may be ineffective as about 75% of the solution diffuses extravascularly into the interstitial space within a short time. [ 15 ] Colloids have a slightly higher osmotic pressure than Ringer's solution or saline. [ 2 ] A plasma substitute volume ≥500 mL infused during the operation was noted to be a significant risk factor for TUR syndrome in Nakahira et al .…”

“…[ 2 ] Anaphylactic reactions may also occur with colloids administration; this risk is rare but cannot be acceptable for prophylaxis. [ 15 ]…”

“…In contrast, HS is more effective, as it can remain in the intravascular space longer than crystalloid solutions and induces instantaneous mobilization of endogenous fluid along the osmotic gradient from the intracellular to the extracellular compartment. [ 15 ] In addition, Mouren et al . [ 17 ] found that HS increases myocardial contraction and induces vasoconstriction.…”

“…There is more chance of water intoxication during TURP with the infusion of the isotonic solution in an excess amount to prevent hypotension together with the absorption of irrigation fluid during resection. [ 15 ] HS (3% NaCl) has an osmolality of 1026 mOsmol/L, which is about three times that of plasma and its infusion, unlike NS, is not associated with free water intoxication. [ 15 ]…”