The use of ethanol as a marker to detect and quantify the absorption of irrigation fluid during transurethral resection of the prostate

• During transurethral resection of the prostate (TURP), the irrigation fluid is often absorbed by the circulatory system and/or the region around the prostate occasionally resulting in severe signs and symptoms. Instant detection and quantification of absorption of irrigation fluid have not been possible earlier. A method involving tagging of the irrigation fluid with ethamol for detection and quantification of absorbed irrigation fluid by measurement of ethanol in expired breath (EB) has been developed. The validity of measuring El3 ethanol to detect and quantify absorbed irrigation fluid was studied in 13 patients undergoing TURF. The EB ethanol was compared with three other methods: 1. Isotope tagging of the irrigation fluid and detection of absorbed fluid using a scintillation detector placed over large blood vessels. 2. Measuring changes in serum-sodium every 10 min. 3. Regular interval monitoring (RIM) of the difference between volume used for inigation and volume recovered from patients every 10 min. The method of measming El3 ethanol was found to be highly valid. The possibility of detecting absorption and the incidence of absorption using EB ethanol in the clinical routine was studied in 192 patients undergoing TURP. Half of them absorbed irrigation fluid, 25% absorbed more than 400 ml. The proportion of patients absorbing inigationlhlld was the same for both experienced and inexperienced resectionists. Clinical assessment of absorption of irrigation fluid was perfonned by the resectionists and the supervising nurses in 118 patients undergoing TURP. Prerequisites for massive absorption were found by the resectionist in 8/9 patients. The resectionist falsely indicated absorption in 22 patients. The nurses conectly indicated 3/9 patients and falsely indicated 4 patients. To investigate the method measuring EB ethanol to detect absorption of inigation fluid during general anaesthesia, 20 patients undervent TURP and EB ethanol was compared to the RIM method. There was a good correlation between the methods. Elevated pressure in the bladder-prostatic fossa is a prerequisite for absorption of irrigation fluid. Detection and quantification of absorbed irrigation fluid by EB ethanol was used for eompming 102 patients operated on with and without a pressure warning device alarming at 1.5 kPa in the bladder. Using the device reduced both the volume of absorbed irrigation fluid, and the number of patients absorbing irrigation fluid. Both ethanol per se and haemodilution by absorbed irrigation fluid may have impacts on the coagulation system. To investigate the influence of absorption of ethanol tagged mannitol on bleeding time, measurements were perl'omed before and after TURP in 57 patients. No difference in bleeding time was found among patients who absorbed irrigation fluid as compared to those who did not. In conclusion, measurement of ethanol in EB for detection and qum1tification of absorbed irrigation fluid is a highly valid method when compared to three other methods. Absorption of irrigation fluid was found in 50% of the patients tmdergoing TURP. Clinical assessments of absorption of irrigation fluid are inreliable. EB ethanol can be used in patients dllling general anaesthesia. Using a pressure warning device decreases the volume of absorbed irrigation fluid, a~ well as the number of patients absorbing it. Absorption of etillmol tagged mannitol as irrigation fluid has no influence on bleeding time.

Nyckelord

Ethanol monitming

expired breath ethanol

irrigation fluid absorption

transurethral resection of the prostate

benign prostatic hyperplasia

MEDICINE

MEDICIN

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