TURP/TURM and major gynaecological anaesthesia: TURP syndrome and shared themes

Model answer

Path (5). Hypotonic electrolyte-free distension media (glycine 1.5%, sorbitol 3%) absorbed intravascularly → dilutional hyponatraemia with hypervolaemia, plus hyperglycinaemia with glycine media.^[1][2]

Rx (5). Stop the procedure and fluid inflow; supportive care with fluid restriction and diuresis for asymptomatic dilutional hyponatraemia; hypertonic sodium chloride infusion for symptomatic hypervolaemic hyponatraemia, per local protocol.^[1]

Positioning (5). Positioning-related perioperative nerve injury is multifactorial — practitioner positioning and padding as well as patient comorbidity and pre-existing neuropathy; closed-claims analysis found most injuries permanent and supine positioning over-represented in brachial plexus claims. State the preventive positioning and padding check per local protocol.^[3]