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The Patient for Prostatic Surgery

  • William T. Gentry

Abstract

The patient, a 70-year-old man, was admitted to the hospital with progressive urinary hesitancy of 2 years’ duration. Significant past medical history included hypertension and mild chronic obstructive pulmonary disease (COPD). The patient had been taking Clonidine 0.1 mg po b.i.d. and theophylline 300 mg po b.i.d. On physical examination blood pressure was 140/80 mmHg; heart rate was 68/min and regular. On auscultation the heart sounds were normal, without murmurs, gallop, or friction rub. The ECG was reported as essentially normal with nonspecific ST-T wave changes. Auscultation of the lungs revealed decreased breath sounds on both sides but no wheezing.

Laboratory values on admission showed serum sodium level 141 mEq/L, potassium 4.6 mEq/L, chloride 103 mEq/L, and total CO2 content 26 mEq/L. Fasting blood glucose level was 100 mg/dl, and creatinine 0.9 mg/dl. The hematocrit was 42%, and urine specific gravity was 1.012.

The patient was scheduled for transurethral prostatectomy (TURP). It was anticipated that the procedure would last about 90 min, and spinal anesthesia was selected.

Keywords

Chronic Obstructive Pulmonary Disease Disseminate Intravascular Coagulation Regional Anesthesia Transurethral Resection Serum Sodium Level 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Malchior J, Valk WL, Foret JD, et al: Transurethral prostatectomy: Computerized analysis of 2,223 consecutive cases. J Urol 1974;112:634–42.Google Scholar
  2. 2.
    Desmond J: Serum osmolality and plasma electrolytes in patients who develop dilutional hyponatremia during transurethral resection. Can J Surg 1970; 13:116–121.PubMedGoogle Scholar
  3. 3.
    Mebust MK, Brody TW, Valk WL: Observations on cardiac output, blood volume, central venous pressure, fluid and electrolyte changes in patients undergoing transurethral prostatectomy. J Urol 1970;103:632–36.PubMedGoogle Scholar
  4. 4.
    Fox M, Hammonds JC, Copland RF: Prostatectomy in patients of 70 and over. Eur Urol 1981;7:27–30.PubMedGoogle Scholar
  5. 5.
    Harrison RH, Boren JS, Robinson JR: Dilutional hyponatremia: Another concept of the transurethral prostatic resection reaction. J Urol 1956,75:95–110.PubMedGoogle Scholar
  6. 6.
    Muravick S: The physiologic and pharmacologic implications of aging. ASA Annual Refresher Course Lectures, 1986, p 275.Google Scholar
  7. 7.
    McLesky CH: Anesthesia for the elderly patient. IARS Review Course Lectures, 1986, pp 136–38.Google Scholar
  8. 8.
    Sagalowsky AI: Hyperplasia and carcinoma of the prostate, in Harrison’s Principles of Internal Medicine. New York: McGraw-Hill, 1987; p 1583.Google Scholar
  9. 9.
    Mazze RI: Anesthesia for patients with abnormal renal function and genitourinary operations, in Miller RD (ed): Anesthesia. New York: Churchill Livingstone, 1986; pp 1651–59.Google Scholar
  10. 10.
    Taylor RO, Maxson ES, Carter FH, et al: Volumetric gravimetric and radioisotopic determination of fluid transfer in transurethral prostatectomy. J Urol 1958;79:490–99.PubMedGoogle Scholar
  11. 11.
    Oester A, Madsen PO: Determination of absorption of irrigating fluid during transurethral resection of the prostate by means of radioisotopes. J Urol 1969;102:714–19.PubMedGoogle Scholar
  12. 12.
    Henderson DJ, Middleton RG: Coma from hyponatremia following transurethral resection of prostate. Urology 1980;15:267–71.PubMedCrossRefGoogle Scholar
  13. 13.
    Logie JRC, Keenan RA, Whiting PH, et al: Fluid absorption during transurethral prostatectomy. Br J Urol 1980;52:526–28.PubMedCrossRefGoogle Scholar
  14. 14.
    Aprison MH, Werman R: The distribution of glycine in cat spinal cord and roots. Life Sci 1955;4:2075.CrossRefGoogle Scholar
  15. 15.
    Wang JM, Wong KC, Creel DJ, et al: Effects of glycine on hemodynamic responses and visual evoked potentials in the dog. Anesth Analg 1985;64:1071–77.PubMedCrossRefGoogle Scholar
  16. 16.
    Ovassapian A, Joshi CW, Brumer EA: Visual disturbances: An unusual symptom of transurethral prostatic resection. Anesthesiology 1982;52:332–34.CrossRefGoogle Scholar
  17. 17.
    Brechner T, Krechel S: Anesthesia for urologic procedures in the aged, in Krechel SW (ed): Anesthesia and the Geriatric Patient. New York: Grune & Stratton, 1984, pp 209–19.Google Scholar
  18. 18.
    Robinson MRG, Cross RJ, Shetty MB, et al: Bacteremia and bacteriogenic shock in district hospital urologic practice. Br J Urol 1980;52:10–14.PubMedCrossRefGoogle Scholar
  19. 19.
    Marx GF, Orkin LR: Complications associated with transurethral surgery. Anesthesiology 1962;23:802–13.PubMedCrossRefGoogle Scholar
  20. 20.
    Friedman NJ, Hoag MS, Robinson AF, et al: Hemorrhagic syndrome following transurethral prostatic resection for benign adenoma. Arch Intern Med 1969; 124:341–49.PubMedCrossRefGoogle Scholar
  21. 21.
    Osborn DE, Rao PN, Green MJ, et al: Fluid absorption during transurethral resection. Br Med J 1980;281:1549–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Madsen PO, Naber KG: The importance of the pressure in the prostatic fossa and absorption of irrigating fluid during transurethral resection of the prostate. J Urol 1973;109:446–52.PubMedGoogle Scholar

Copyright information

© Birkhäuser Boston Inc. 1989

Authors and Affiliations

  • William T. Gentry

There are no affiliations available

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