Anaesthesia for Gynaecological and Genitourinary Surgery
TRANSURETHRAL RESECTION (TUR) SYNDROME
TUR syndrome occurs if a large volume of hypotonic irrigating solution is absorbed rapidly, resulting in rapid changes in serum osmolality and electrolyte concentrations. Glycine solution is the most commonly used hypotonic irrigating fluid in the UK, and commercial solutions have an osmolality of approximately 200 mosmol L− 1. In high concentrations, glycine can exhibit toxic effects on the cardiovascular and central nervous systems (including retinal neurotransmission) in addition to the effects of altered blood chemistry. The clinical findings associated with TUR syndrome are shown in Table 27.1.
TABLE 27.1
Clinical Features of TUR Syndrome
Symptoms in the Awake Patient | Clinical Signs and Investigation Results |
Vertigo | Confusion or agitation |
Nausea and/or vomiting | Decreased consciousness |
Abdominal pain | Seizures |
Visual disturbance/blurred vision Dyspnoea Chest tightness | Pupillary dilatation Papilloedema Bradypnoea/hypopnoea Pulmonary oedema Cyanosis Oliguria Hypotension (although there may be initial hypertension) Bradycardia or other dysrhythmias Widened QRS and/or ST changes on ECG Cardiac arrest Hyponatraemia Decreased serum osmolality Hyperammonaemia |