Term
| During a TURP, how much fluid is absorbed before you see symptoms of TURP syndrome? What are those syndromes? |
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Definition
2 liters or more
headache, restlessness, confusion, cyanosis, dyspnea, arrhythmias, hypotension, seizures, death |
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Term
| What are the symptoms of TURP syndrome due to? |
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Definition
| Fluid overload, water intoxication, and occasionally from the solute in the irrigation fluid, which are absorbed into the venous sinuses of the prostate. |
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Term
What can happen when sodium levels are 120 meq/L?
115?
<100? |
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Definition
120 = neurological symptoms
115 = widening of QRS, ST segment elevation
<100 = VT/VF |
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Term
| Why is regional a nice technique for TURP? What level is needed? |
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Definition
Provides an ability to check neuro status
T10 |
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Term
| What should you do if you suspect your patient has TURP syndrome? |
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Definition
Draw lytes and serum osmolarity.
Supportive treatment includes intubation if needed to help maintain saturation, stopping the procedure, lasix 0.5 mg/kg, hypertonic saline |
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Term
| What are the manifestations of TURP syndrome? |
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Definition
Hyponatremia
Hypoosmolarity
Fluid overload
Hemolysis
Hyperglycinemia
Hyperammonia (from glycine)
Hyperglycemia (from sorbitol) |
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Term
| What are the factors that affect uptake of irrigation solution? Which are most important? |
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Definition
Height of irrigation bag
Duration of resection
Size of gland resection
Congestion of the gland
Number of sinuses open
Experience of surgeon |
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Term
| What is the average rate of absorption of irrigant during a TURP? |
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Definition
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Term
| Bladder perforation is a complication of TURP. If the TURP is done under general, how is bladder perf. detected? |
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Definition
| Only the surgeon can detect if under general b/c he/she will see less bladder fluid returned. |
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Term
| Symptoms of bladder perf. depend on whether the perforation is located where? Which is harder to detect? |
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Definition
Intraperitoneal or extraperitoneal.
Extraperitoneal |
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Term
| What are symptoms of intraperitoneal rupture? |
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Definition
Abdominal rigidity, distention, and pain (suprapubic)
Referred shoulder pain
Hiccups
Tachycardia
SOB
Hypo/hypertension
Diaphoresis
Vomiting |
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Term
What are symptoms of extraperitoneal rupture?
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Definition
Periumbilical inguinal (pain, I'm assuming?)
or lower abdominal extension |
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Term
| Hyperglycinemia is a complication of TURP. What is glycine, and what happens with hyperglycinemia? |
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Definition
Glycine is the #2 inhibitory neurotransmitter.
Hyperglycinemia causes transient blindness. Glycine is degraded to ammonia (which can also lead to CNS depression.) |
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Term
Lithotripsy (extracorporeal shock wave lithotripsy) uses high energy repetitive shocks (sound waves) focused on the stone that causes it to fragment. Why is tissue not damaged in this procedure?
What areas are vulnerable to damage? |
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Definition
Tissue has the acoustic density of water and thus no damage is done.
Air filled tissue (lungs and guts) are vulnerable to destruction, thus, an inability to position to avoid these areas is a contraindication. |
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Term
| What are contraindications to lithotripsy? |
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Definition
Pregnancy
Stone below the obstruction
Inability to position correctly
Bleeding diathesis
Untreated infection
(aortic aneurysm and orthopedic prosthetics are RELATIVE contraindications) |
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Term
| Patients with a history of cardiac arrhythmias and those with pacers/ICDs may be at risk for arrhythmias produced by shock waves. What should be done to help? |
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Definition
| The lithotripsy should be synchronized with the R wave on the EKG to reduce the risk of arrhythmias. The shock is times to 20 ms after the R wave occurs (to hopefully occur during absolute refractory) |
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Term
| If a patient has no history of arrhythmias, does the lithotripsy machine need to be synched? |
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Definition
| No, asynchronous delivery is usually safe. |
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Term
| Run through the hemodynamic effects of water immersion for litho. |
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Definition
| The patient is placed in a heated water bath, which can lead to vasodilation and hypotension. The pressure of the water on the legs usually improves preload, however, and arterial BP will rise. SVR increases, CO decreases. The increased preload and afterload can potentiate CHF in pts with poor LV function. Also, the increased intrathoracic blood volume decreases FRC, potentially leading to hypoxia. |
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Term
| What type of anesthetic plan is often used for non-immersion litho? |
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Definition
| MAC is often used (procedure can be painful). If pt c/n lie still, general should be used. |
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Term
| If using an epidural for water immersion litho, what level is needed, and what special considerations are needed? |
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Definition
T6 sensory level needed.
Little air should be used for loss of resistance because air can dissipate the shock waves. Foam tape should not be used to secure the epidural because it dissipates the shock wave.
Light sedation + oxygen works well. |
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Term
| Although a spinal might work okay for water litho, what might need to be considered? |
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Definition
| The patient is in a sitting position in the tank, which may increase the incidence of PDPH, and there is less control over the level of the block. |
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Term
| A radical cystectomy is a big surgery, where bladder is removed, and the ureters are rerouted to a bowel segment. The bowel segment is either used to form a pseudo bladder or attached to a cutaneous stoma. Why might regional be a bad idea for this? |
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Definition
| Regional technique may lead to a contracted bowel and hyperparastalis--making it more difficult for the surgeon to operate. |
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Term
| What are the anesthetic implications of a radical cystectomy? |
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Definition
1. Possible hypotensive technique
2. Want them well hydrated, and they will have significant evaporative loss (huge incision)
3. CVP is often used to manage fluids
4. Consider A-line if limited cardiac reserve (or hypotensive technique)
5. need to work to keep them warm!
6. Type and cross
7. Prolly gonna need muscle relaxation |
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