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Cardiorespiratory Crisis in TURP Syndrome: How One Small Change Could Affect Your Life?
When performing a transurethral resection of the prostate (TURP), medical professionals always have to be aware of possible complications, the most serious of which is TURP syndrome. This is a potentially fatal complication caused by the absorption of the instilled fluid during surgery, which enters the prostatic venous fossa and causes a variety of uncomfortable symptoms. The diversity and unpredictability of this condition require clinicians to be highly alert in order to quickly recognize and treat it.
For patients who feel unwell after surgery, early detection of any abnormal symptoms and timely intervention will significantly improve their chances of survival.
Symptoms and signs
The clinical manifestations of TURP syndrome vary in severity and are primarily due to fluid overload and electrolyte imbalance. Symptoms are broad and often nonspecific, making early diagnosis of TURP syndrome difficult clinically. Typically, the most common manifestations include abnormalities of the central nervous system, cardiopulmonary system, and systemic system.
Central nervous system
Patients may experience a range of neurological symptoms including: irritability, headache, nausea and vomiting, confusion, visual disturbances, cerebral edema, seizures and even coma.
Cardiopulmonary system
In terms of cardiopulmonary function, patients may experience bradycardia, hypotension or hypertension, tachypnea, hypoxia, cyanosis and pulmonary edema.
Systemic
Systemic symptoms may include hypothermia and abdominal pain or bloating.
PathophysiologyThe pathophysiology of TURP syndrome is quite complex. The most common perfusion fluids such as glycine, sterile water and glucose solutions may cause a series of adverse reactions after being absorbed into the blood. Excessive fluid absorption will cause a rapid expansion of blood volume, which will in turn cause hypertension and reflex slowing of heart rate. Ultimately, these changes may lead to pulmonary and cerebral edema, particularly in patients with impaired left ventricular function.
Hyponatremia caused by excessive fluid absorption can lead to cerebral edema and increased intracranial pressure, and the manifestations vary depending on the degree of hyponatremia.
Diagnosis
There are no definitive criteria for diagnosing TURP syndrome, and physicians must be vigilant, especially in patients who are unwell after surgery.ア
Additional indicators are obtained by observing the patient's state of consciousness, ultrasound examination, and laboratory test results; for example, hyponatremia (sodium <120 mmol/L) can strongly suggest that the patient may have TURP syndrome.
Prevention
Given the potential for severe morbidity and mortality from TURP syndrome, preventive measures during the preoperative period are critical. The choice of appropriate anesthesia, type of instillation fluid, and duration of surgery will affect the risk of complications.
Management
Treatment of TURP syndrome is primarily supportive and requires early diagnosis and intervention. If relevant symptoms occur after surgery, the operation should be terminated immediately and the patient should be transferred to a higher-care unit with continuous monitoring of vital signs.
Patients with dyspnea or pulmonary edema should be given high-flow 100% oxygen immediately and may require positive pressure ventilation. During the monitoring process, blood pressure should be monitored through a central line and an arterial line, and positive inotropic drugs can be used to support blood pressure when necessary.
If TURP syndrome is detected and managed promptly, the development of many diseases can be avoided.
In conclusion, for patients affected by TURP syndrome, early identification, rapid response, and effective management are key to avoiding serious complications. Faced with such a challenge, how prepared are you to respond and whether this information will affect your choices during surgery?
