Vaz Ana Sofia Ferreira Pires, Ribeiro Sandy, Lopes José Duarte, Figueiredo Eduarda
Anesthesiology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
J Endourol Case Rep. 2020 Dec 29;6(4):336-338. doi: 10.1089/cren.2020.0127. eCollection 2020.
Transurethral resection of the prostate (TURP) syndrome is a rare, but extremely dangerous complication. We present an even rarer case of a spinal cord injured patient who developed "TURP-like syndrome" after cystoscopy with Double-J replacement, under general anesthesia. A 39-year-old man, American Society of Anesthesiologists III, tetraplegic, was scheduled for cystoscopy with bilateral Double-J replacement. Preoperative values of serum sodium were 133 mmol/L and potassium 5 mmol/L. To prevent autonomic dysreflexia, we performed general anesthesia. During cystoscopy, 0.9% NaCl irrigating fluid reservoir was fixed 50 cm above patient level and pressure was applied at urologist's request. The balance between inflow and outflow of irrigation fluids showed no significant difference. Procedure lasted 25 minutes, without any complications. Patient was transferred, awake, to postanesthesia care unit and discharged 1 hour later to the ward. Four hours later, patient referred nausea, headache, and abdominal pain. Acetaminophen and ondansetron were administered. Arterial blood gas sample revealed metabolic acidosis, hyponatremia, and hyperkalemia. A fluid resorption syndrome was assumed, furosemide was given, 0.9% NaCl was loaded, followed by 3% NaCl, and 1.4% NaHCO for metabolic acidosis. A 5% glucose solution with 10 U insulin was started for hyperkalemia correction. In 24 hours, patient's clinical state improved and serum sodium and potassium values returned to baseline levels. A week after surgery, patient was discharged home, without neurologic damage. Excessive absorption of irrigation fluids during cystoscopy may occur and manifestations may be delayed in up to 24 hours postoperatively. Anesthesiologists and urologists must be aware of this life-threatening situation. Preventive measures, rapid detection, and treatment are imperative and may prevent complications and, ultimately, death.
经尿道前列腺切除术（TURP）综合征是一种罕见但极其危险的并发症。我们报告了一例更为罕见的病例，一名脊髓损伤患者在全身麻醉下进行膀胱镜检查并更换双J管后出现了“TURP样综合征”。一名39岁男性，美国麻醉医师协会分级为III级，四肢瘫痪，计划进行双侧双J管更换的膀胱镜检查。术前血清钠值为133 mmol/L，钾值为5 mmol/L。为预防自主神经反射异常，我们实施了全身麻醉。膀胱镜检查期间，0.9%氯化钠冲洗液储液器固定在患者水平上方50 cm处，并根据泌尿科医生的要求施加压力。冲洗液的流入和流出平衡无显著差异。手术持续25分钟，无任何并发症。患者清醒后被转至麻醉后护理单元，1小时后出院至病房。4小时后，患者出现恶心、头痛和腹痛。给予对乙酰氨基酚和昂丹司琼。动脉血气样本显示代谢性酸中毒、低钠血症和高钾血症。考虑为液体吸收综合征，给予呋塞米，输注0.9%氯化钠，随后输注3%氯化钠，以及1.4%碳酸氢钠治疗代谢性酸中毒。开始使用含10 U胰岛素的5%葡萄糖溶液纠正高钾血症。24小时内，患者的临床状态改善，血清钠和钾值恢复至基线水平。术后一周，患者出院回家，无神经损伤。膀胱镜检查期间可能会发生冲洗液的过度吸收，其表现可能会在术后长达24小时出现延迟。麻醉医生和泌尿科医生必须意识到这种危及生命的情况。预防措施、快速检测和治疗至关重要，可预防并发症并最终避免死亡。
