Critical Care and Shock

Efficacy and Safety of Preoperative Administration of Half Molar Hypertonic Sodium Lactate during Transurethral Resection of Prostate (TURP)

Abstract

Background: Water irrigation during transurethral resection of prostate (TURP) often caused hyponatremia, hypoosmolality, and decreasing of pH called TURP syndrome. Current standard fluid therapy in TURP still could not prevent or correct TURP syndrome. This study was aimed to assess the efficacy and safety of preoperative hypertonic sodium lactate (HSL) infusion in maintaining plasma sodium level, osmolality, arterial pH and hemodynamic parameters during TURP compared to normal saline (NS).

Methods: In this prospective randomized controlled double blind study, 22 patients underwent TURP surgery under spinal anesthesia were assigned into 2 groups with 11 patients in each group. HSL or NS were administered before spinal anesthesia with loading dose 4 mL.kgBW-1 within 20 minutes. During procedure NS with 2-4 mL.kgBW-1.hr-1 were infused as maintenance in both groups.

Result: Postoperative mean of sodium level and osmolality in HSL group was significantly different compared to NS group (142.2±2.0 mEq/L vs 138.9±2.1 mEq/L, p<0.05, and 294.6±3.5 mOsm/kg vs 290.6±3.2 mOsm/kg, p<0.05) respectively. Postoperative pH in HSL group was 7.433±0.04, whereas in NS group was 7.356±0.05 (p<0.05). Evolution of hemodynamic parameters was better in HSL group. Five of 11 patients in NS group need ephedrine injection due to decreased of blood pressure >30% after spinal anesthesia, whereas none of patients in HSL group need ephedrine.

Conclusion: Preoperative administration of hypertonic sodium lactate in TURP was better in maintaining plasma sodium level, osmolality, arterial pH and also hemodynamic parameters than normal saline.