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

Meet the patient

Forty minutes into a monopolar TURP under spinal anaesthesia, the patient who was chatting becomes restless and nauseated and says the lights look dim. The registrar reaches for midazolam. That is the wrong reflex — restlessness under the drapes is TURP syndrome until proven otherwise, and sedation masks the only monitor you have. (Taught vignette; the review-exact presentation is hyponatraemia with bradycardia and hypotension, sometimes preceded by hypertension, after hypotonic glycine absorption through the prostatic venous plexus [5].)^[4][5]

The question that decides this patient's next ten minutes is the question that decides every TURP: has hypotonic irrigant been absorbed through open prostatic venous sinuses, and is the sodium falling? Stop the irrigation first, send urgent electrolytes, and prepare for hypertonic saline if the neurology worsens. Hold that question and the physiology below is obvious. (Taught decision rule — absorption frequency 1–2 L in 5–10% of TURP patients with mild easily-overlooked TUR syndrome per [4].)^[4]

References8ShowHide

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