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PATIENT SAFETY

Transurethral Resection Syndrome Detected and Managed Using Transesophageal Doppler

Patrick Schober, MD^*, Eric J.H. Meuleman, PhD, Christa Boer, PhD^*, Stephan A. Loer, PhD^*, and Lothar A. Schwarte, PhD, DESA, EDIC^*

From the Departments of *Anesthesiology, and Urology, VU University Medical Center, Amsterdam, The Netherlands.

Address correspondence to and reprint requests to Lothar A. Schwarte, MD, PhD, DESA, EDIC, Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands. Address e-mail to L.Schwarte{at}vumc.nl.

Abstract

Transurethral resection syndrome during transurethral resection of the prostate (TURP) results from excessive absorption of electrolyte-free irrigation fluids causing acute hypervolemia and hyponatremia. Neuraxial anesthesia is often recommended for TURP procedures because early signs of neurological deterioration can be detected. However, in patients requiring general anesthesia, other continuous and noninvasive measures are needed. Acute intravascular hypervolemia should be reflected by changes in hemodynamic values. Transesophageal Doppler ultrasonography of the aorta allows determination of stroke volume and other advanced hemodynamic variables related to intravascular volume status. We describe the first case of intraoperative detection of a TURP syndrome by noninvasive Doppler monitoring of hemodynamic variables during TURP.

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