OBJECTIVE: In a prospective study it was our intention to evaluate the
reliability and the predictive value of expiratory ethanol for the early
detection of the occurrence of TURP syndrome and emphasize the role of the serum
levels of glycine in clinical manifestation.
METHODS: We studied 30 patients scheduled for elective traditional transuretral
resection of the prostate performed with subarachnoid anesthesia. Serum sodium
and glycine concentrations, serum osmolality and end-expiratory ethanol levels
were monitored at scheduled intervals. Continuous heart rate and blood pressure
monitoring was performed during the perioperative period in the operativing room
and, later, in the recovery room. Occurrence of cardiocirculatory, respiratory
and neurologic symptoms were recorded. Statistics included Bonferroni's t-test
and Fisher's exact test. A decision level plot for end-expiratory ethanol level
was performed for the choice of predictivity criterion.
RESULTS: In our population we identified three groups of patients: Group I (15
patients) in which no symptom was recorded; Group II (6 patients) in which
non-specific anesthesia-related symptoms occurred; Group III (9 patients) in
which TURP syndrome of various degree of severity was observed. In this group of
patients changes in serum sodium and glycine concentrations, serum osmolality and
end-expiratory ethanol levels were significantly different compared with the
other two groups. In regard to end-expiratory ethanol levels, we identified a
cut-off point at 0.05 mg/ml. In Group III two patients developed transient
blindness. These patients had the highest serum glycine concentrations (> 4000
mumol/ml). Mortality was nil.
CONCLUSIONS: Our data show the reliability and accuracy of end-expiratory ethanol
levels as a predictive test of the occurrence of TURP syndrome. Further, we
emphasize the role of serum glycine concentration in the occurrence of neurologic
symptoms related to the transurethral resection of the prostate