Fluid absorption in endoscopic surgery

Abstract

Fluid absorption is an unpredictable complication of endoscopic surgery. Absorption of small amounts of fluid (1-2 litre) occurs in 5-10% of patients undergoing transurethral prostatic resection and results in an easily overlooked mild transurethral resection (TUR) syndrome. Large-scale fluid absorption is rare but leads to symptoms severe enough to require intensive care. Pathophysiological mechanisms consist of pharmacological effects of the irrigant solutes, the volume effect of the irrigant water, dilutional hyponatraemia and brain oedema. Other less widely known factors include absolute losses of sodium by urinary excretion and morphological changes in the heart muscle, both of which promote a hypokinetic circulation. Studies in animals, volunteers and patients show that irrigation with glycine solution should be avoided. Preventive measures, such as low-pressure irrigation, might reduce the extent of fluid absorption but does not eliminate this complication. Monitoring the extent of absorption during surgery allows control of the fluid balance in the individual patient, but such monitoring is not used widely. However, the anaesthetist must be aware of the symptoms and be able to diagnose this complication. Treatment should be based on administration of hypertonic saline rather than on diuretics. New techniques, such as bipolar resectoscopes and vaporizing instead of resecting tissue, result in a continuous change of the prerequisites for fluid absorption and its consequences.

Absorption of Irrigation Fluid Occurs Frequently during High Power 532 nm Laser Vaporization of the Prostate

“…Thus, it is likely that in the absence of low-pressure irrigation and ethanol monitoring higher volumes of fluid absorption and potentially a higher rate of clinical symptoms would have been detectable. Hyponatremia, which can be used as indicator for fluid absorption if hypo-osmolar solutions are used 4 was not detectable in the present investigation because isotonic fluid was used.…”

“…However, in contrast to ethanol, conventional blood parameters are also affected by the amount of fluids given intravenously and therefore are not reliable to monitor fluid absorption. 4,10 A limitation to our study is that it was not powered to analyze potential risk factors for fluid absorption during LV of the prostate in detail. Therefore, we did not perform statistical analyses but only exploratory analyses for this aspect.…”

“…3 Furthermore, intraoperative irrigation with isotonic saline prevents the development of a classical TUR-syndrome, which is known to be a result of excess influx of electrolyte-free glycine solution into the vascular system during transurethral surgery. 4 Finally, it is postulated that synchronous tissue coagulation during LV inhibits absorption of irrigation fluid in general. 5 Extensive absorption of irrigation fluid, even isotonic, carries the risk of cardiopulmonary complications particularly in patients with preexisting cardiovascular risk factors.…”

“…5 Extensive absorption of irrigation fluid, even isotonic, carries the risk of cardiopulmonary complications particularly in patients with preexisting cardiovascular risk factors. 4,6 Fluid absorption was undetectable during LV using the first generation low-power (80W) 532nm laser. 7 However, data on irrigation fluid absorption during LV using the secondgeneration high-power (120W) laser is lacking.…”

Transurethral resection of prostate: a comparison of standard monopolar versus bipolar saline resection

“…Irrigant fluid absorption by the patient is a potentially serious complication of TURP, resulting in the TURP syndrome with appreciable morbidity and mortality (1,2).…”