الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Fluid absorption is an unpredictable complication of endoscopic surgery. Absorption of small amounts of fluid (1–2 liters) occurs in 5–10% of patients undergoing transurethral prostatic resection and results in an easily overlooked mild transurethral resection (TUR) syndrome. Large-scale fluid absorption is rare but leads to symptoms severe enough to require intensive care. Pathophysiological mechanisms consist of pharmacological effects of the irrigant solutes, the volume effect of the irrigant fluid, dilutional hyponatraemia and brain oedema. Other less widely known factors include absolute losses of sodium by urinary excretion and morphological changes in the heart muscle, both of which promote a hypokinetic circulation. Current standard fluid therapy in TURP still could not prevent TUR syndrome. This study was aimed to assess the efficacy and safety of intraoperative hypertonic saline 3% (HSL) infusion with a dose of 2.5 ml/kg in maintaining plasma sodium level, osmolality and hemodynamic parameters during TURP compared to normal saline (NSL) infusion with a dose of 3 ml/kg.= In this prospective randomized controlled double blind study, 74 patients underwent TURP procedure under spinal anesthesia were categorized into 2 groups with 37 patients in each one. In both groups patients received 3ml/kg normal saline 0.9% just after starting the resection for 15 minutes then according to randomization one group received 2.5ml/kg hypertonic saline 3% for 15 minutes and the other group received 3ml/kg normal saline 0.9% for 15 minutes. Intraoperative and postoperative serum sodium changes in HSL group were significantly different compared to NSL group (P value< 0.05). Changes of mean arterial pressure were statistically highly significant starting from 20 minutes after administration of hypertonic saline 3% till 30 minutes in the recovery room. Visual status, shivering and nausea and vomiting showed high significant difference between two groups (P value<0.01) Intraoperative administration hypertonic saline 3% with a dose of 2.5 ml/kg was better in maintaining plasma sodium concentration and hemodynamic stability during TURP than isotonic saline 0.9% with a dose of 3 ml/kg and could reduce the occurrence of TURP syndrome. Hypertonic sodium chloride 3% with a dose of 2.5 ml/kg might be a choice of intraoperative fluid regimen during TURP procedure.