Evaluation of Intravascular Volume Status by Pleth Variability Index in Transurethral Prostate Resections

Abstract

Objective: Patients with benign prostatic hypertrophy (BPH) are treated with transurethral resection of the prostate (TURP). The passage of irrigation fluid into the systemic circulation can cause hypervolemia, hyponatremia and due to them TURP syndrome with restlessness, confusion, dyspnea, arrhythmia and seizures. The most important point is early diagnosis. Our aim was to reveal the statistical relationship between serum sodium (Na) values and the pleth variability index (PVI) in patients who underwent TURP. Methods: Thirty-three ASA I-III and 40-80 years old patients who underwent TURP under spinal anesthesia were included in the study. The patients were taken to the operating room and standard monitoring was applied. Venous blood samples were taken from the peripheral vascular access before and after the procedure, and Na values were determined; PVI values were recorded at 5-minute intervals from the preoperative period to the postoperative period by performing PVI monitoring. Results: The PVI data correlated with postoperative osmolarity, postoperative Na concentration, resection time and irrigation amount as an early predictor of hypervolemia and seconder hyponatremia. Conclusion: We think that more comprehensive case studies are needed in terms of the usability of PVI, which is a noninvasive method compared to blood gas sampling, an invasive method for the diagnosis of hypervolemia and hyponatremia, and that continuous monitoring and follow-up provide an advantage in early diagnosis. Keywords: Pleth variability index, benign prostatic hypertrophy, TURP, osmolarity, amount of irrigation