Water and Electrolytes in Muscle Tissue and Free Amino Acids in Muscle and Plasma in Connection with Transurethral Resection of the Prostate. II

Norlén, Henrik; Dimberg, Mats; Allgén, Lars-Göran; Vinnars, E.

doi:10.3109/00365599009180371

Cited by 9 publications

(1 citation statement)

References 13 publications

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“…33 51 56 The half-life is dosedependent 36 which is probably due to intracellular accumulation of glycine. 86 Penetration into the central nervous system is restricted, 126 but may be clinically important. 112 Elimination of glycine occurs primarily in the liver, yielding ammonia.…”

Section: Pharmacokinetics and Pharmacodynamicsmentioning

confidence: 99%

Fluid absorption in endoscopic surgery

Hahn

2006

British Journal of Anaesthesia

201

144

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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.

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Section: Pharmacokinetics and Pharmacodynamicsmentioning

confidence: 99%

Fluid absorption in endoscopic surgery

Hahn

2006

British Journal of Anaesthesia

201

144

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Long-term changes in muscle free amino acid levels after elective abdominal surgery

Petersson

Vinnars

Waller

et al. 1992

Journal of British Surgery

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Characteristic changes in the pattern of muscle free amino acids are seen on the third day after elective surgery. The time course of the restoration to normal levels in uncomplicated cases has not been established before. Seven metabolically healthy patients undergoing cholecystectomy were studied. Muscle biopsy specimens and plasma samples were taken before operation and on days 3, 10, 20 and 30 after surgery. The level of total free amino acids in skeletal muscle decreased and the concentrations of branched chain and aromatic amino acids increased on day 3. The original levels were found to be restored on day 10 after surgery. A decrease in glutamine of 38 per cent (P less than 0.001) was seen on day 3, of 20 per cent (P less than 0.05) on day 10 and of 22 per cent (P less than 0.05) on day 30, compared with preoperative values. These results constitute a baseline for future studies in which the impact of nutritional and pharmacological therapies is to be evaluated beyond the immediate postoperative period.

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