What are the anesthetic options for a patient under-going a TURP?

What are the anesthetic options for a patient under-going a TURP?

Regional anesthesia has long been considered the anes-thetic of choice for this procedure. The clear advantage of this technique is the ability to monitor for the early signs of hyponatremia such as irritability and headache. If these occur, a serum Na⁺ level should be checked and hypona-tremia, if confirmed, should be treated expeditiously. It is important to remember that the development of combat-iveness intraoperatively should not be assumed to be inadequate anesthesia. Deepening the anesthetic level with sedation could have a catastrophic effect.

As discussed earlier, another potentially fatal complica-tion of a TURP is bladder perforation. If a T₁₀ level of sen-sory blockade is achieved, the patient would still be able to complain of abdominal or shoulder pain. This complaint would alert the anesthesiologist and the surgeon to the probability of a bladder perforation, and would allow for prompt diagnosis and treatment.

As with other pelvic procedures, regional anesthesia has been shown to decrease blood loss and the incidence of deep vein thrombosis. The decrease in blood loss is most likely secondary to the decrease in blood pressure as well as the decrease in both central and peripheral venous pressure associated with neuraxial anesthesia. A number of different reasons have been postulated for the decreased incidence of deep vein thromboses. One reason may be the increase in peripheral blood flow resulting from the sympathetic blockade. Other reasons include an increase in prothrombin time, a measure of the extrinsic pathway of coagulation, and a decrease in platelet count.

Another clear advantage of regional anesthesia is post-operative pain control. Good postoperative pain control will also allow the patient to avoid the sympathetic response to pain, such as tachycardia and hypertension, which could increase the likelihood of myocardial ischemia in susceptible patients.

The presence of comorbid condition(s) in the patient may necessitate a general anesthetic. It must be appreciated that the early neurologic signs and symptoms associated with hyponatremia, hypo-osmolality or bladder perforation will no longer be available to the anesthesiologist. When a general anesthetic is chosen, a smooth emergence is desirable. If the patient awakens coughing and “bucking” on the endotracheal tube, venous pressure will increase and bleeding may develop.