Evaluation of changes in serum concentration of sodium in a transurethral resection of the prostate.

INTRODUCTION AND OBJECTIVES: The purpose of this study was to evaluate changes in serum electrolytes during Transurethral resection of the prostate (TURP) and to evaluate the degree of correlation of hyponatremia and the factors that affect the incidence of TURP syndrome and to show the impact of the duration of the procedure on the severity of hyponatremia due to absorption of irrigation fluid in the systemic circulation. MATERIALS AND METHODS: This study examined 60 male patients planned for elective TURP. The level of serum electrolytes are determined by taking venous blood samples preoperatively and Postoperatively and when the duration of the operation was longer than 60 minutes, the level of serum electrolytes was determined intraoperative. The amount of used irrigation fluid, the weight of resection prostate, and duration of surgery, were also followed. Patients were divided in two groups according to the length of the surgical procedure: Group 1 (30-60 min) and Group 2 (> 60 min). RESULTS: Statistically significant reduction of serum sodium and the elevation of the potassium level in serum observed postoperatively and was directly proportional to the volume of of the used irrigation fluid, the duration of the procedure and volume of the resected prostate. CONCLUSIONS: To evaluate changes in serum electrolyte during TURP is simple and economical method for the indirect estimation of irrigation fluid absorption into the systemic circulation during TURP and opportunity for early identification of TURP syndrome.

The effect of a small dose of ketamine on postoperative analgesia and cytokine changes after laparoscopic cholecystectomy.

BACKGROUND AND OBJECTIVES: In this study we assesed the effect of a small dose of ketamine on the production of TNFα, IL-1ß and IL-6 and the postoperative pain in patients undergoing laparoscopic cholecystectomy. METHODS: Fifty patients undergoing laparoscopic cholecystectomy were randomized in two equal groups. Patients in the ketamine group after induction in anesthesia received ketamine--025 mg/kg(-1). At the same time patients from the control group received sodium chloride. Postoperatively, the pain was assessed with VAS at periods of 30 min at 1, 2, 4, 8, 18, 24 and 48 hours. TNFα, IL-1ß and IL-6 were evaluated before surgery at 4, 18 and 24h after the operation. RESULTS: Differences of mean values of TNFα and IL-1ß between the two groups in the postoperative period were not significant. Mean values of IL-6 in the investigated group A were significantly lower than the mean values of IL-6 in the investigated group B after the 4th hour (p=0.00990), after the 18th hour (p=0.00133) and as after the 24th hour following surgery (p=000860). the difference in pain intensity according to the VAS scale was also statistically significantly smaller in group A after 30 min, 1,2,8 and 12 hours after surgery. CONCLUSIONS: The addition of a small-dose of ketamine in patiens undergoing laparoscopic cholecystectomy resulted in attenuation of secretion of TNFα, IL-1ß, IL-6 and reduction of postoperative pain.

Improvement of cerebral oxygenation during laparoscopy using intermittent sequential compression of legs.

The creation of CO2 pneumoperitoneum during laparoscopy causes a series of adverse effects. Impairment of brain oxygen saturation during laparoscopy is a result of increased intra-abdominal pressure, absorbed CO2 and increased intracranial pressure. The aim of this study is to investigate the possible effects of pneumatic inter-mittent sequential compression (ISC) of legs on oxygenation of the brain during laparoscopy. 100 patients, ASA groups 1 and 2, subjected to elective laparoscopic cholecystectomy, were included in this study. The patients were divided into two groups consisting of 50 patients each, group I, control group, and group II, where ISC was applied. Oxygen saturation of the mixed venous blood from the internal jugular vein (SjvO2) is an indirect assessment of cerebral oxygen use (oxygenation of the brain). Blood samples were obtained from the bulb of the right jugular vein, as the dominant side for venous drainage from the brain. Informed consent was obtained from each patient. Blood samples of 2 ml were obtained several times during the operation; the first sample immediately after anesthesia induction in order to establish the baseline values of SjvO2, the second sample immediately after the creation of the pneumoperitoneum, and then every 15 minutes respectively until the end of the pneumoperitoneum. The last sample was obtained before the extubation of the patients. The ISC in group II was terminated after obtaining the last blood sample. Results showed that the average values of oxygen saturation of the mixed venous blood from the internal jugular vein--SjvO2 levels were higher in group II where ISC was applied (82.3%→86.4%→85.3%→80.2%→82.8%→80.4%), compared to group I, without ISC (85.5%→77.8%→80.6%→83.8%→84.8%), statistically significant in the second and third measurement for p<0.05 for the second and the third measurement, i.e. after the creation of pneumoperitoneum, when the decreease in the brain oxygenation is most dramatic in the group without ISC. In conclusion, application of intermittent sequential compression of the legs is a simple and safe technique for preserving the brain oxygenation during laparoscopy by restoring the blood return from the legs.