Hypertonic saline for intraoperative fluid therapy in transurethral resection of the prostate

Abstract

We tested hypertonic saline solution (HS) to determine its effectiveness in surgical procedures for prostatic hypertrophy. We randomly selected 40 patients undergoing elective transurethral resection of the prostate for either infusion of HS (3% NaCl) at 4ml·kg⁻¹·min⁻¹ (HS group) or lactated Ringer's solution (LR) at 8 ml·kg⁻¹·min⁻¹ (LR group). Anesthesiologists regulated the intraoperative infusion rate as needed to maintain blood pressure. There were no differences in systolic blood pressure, heart rate, central venous pressure, or arterial blood oxygenation between the two groups. In the HS group, plasma sodium, chloride, and osmolality, measured in the recovery room, were significantly increased; however, they returned to preanesthetic levels the day after surgery. In the LR group, in contrast, plasma sodium decreased significantly and this lower value persisted for 1 day. An osmolar gap exceeding 10mOsm·kg⁻¹ was observed in 2 patients in the HS group, but plasma sodium remained at normal values. However, in the 1 patient in the LR group whose osmolar gap exceeded 10mOsm·kg⁻¹, plasma sodium was 115 mEq·I⁻¹. HS, at a low dose, is useful in the intraoperative management of transurethral resection of the prostate.