The hemodynamic effects of hypertonic saline preload versus co-load measured by non-invasive cardiometry in patients undergoing TURP surgery: a randomized controlled trial | [Anaesthesia, Pain and Intensive Care • 2024]

Author(s):

1. Nazmy Edward Seif: Department of Anesthesia, Surgical ICU, and Pain Management, Faculty of Medicine, Cairo University,Cairo, Egypt

2. Manar Mahmoud El-Kholy: Department of Anesthesia, Surgical ICU, and Pain Management, Faculty of Medicine, Cairo University,Cairo, Egypt

3. Manal Mohamed El-Gohary: Department of Anesthesia, Surgical ICU, and Pain Management, Faculty of Medicine, Cairo University,Cairo, Egypt

4. Shaimaa Ahmed Abdel Ghany Wahba: Department of Anesthesia, Surgical ICU, and Pain Management, Faculty of Medicine, Cairo University,Cairo, Egypt

5. Victor Farouk Jaccoub: Department of Anesthesia, Surgical ICU, and Pain Management, Faculty of Medicine, Cairo University,Cairo, Egypt

Abstract:

Background & objective: Transurethral resection of prostate (TURP) is usually performed under spinal anesthesia. To control spinal hypotension intravenous fluids are infused. We evaluated the effect of timing of hypertonic saline infusion as a preload or a co-load on hemodynamic parameters in patients undergoing TURP using non-invasive cardiometry. Methodology: A randomized controlled study was conducted. A total of 100 ASA physical status I-III patients planned for TURP under subarachnoid block were randomly assigned to either a preload of 4 ml/kg of hypertonic saline (NaCl 3%) over 15-20 min before spinal anesthesia (Group P, n = 50) or a co-load at the maximum rate at the moment of cerebrospinal fluid identification (Group C, n = 50). Cardiometry was used to measure cardiac output and systemic vascular resistance; and mean arterial blood pressure, systolic blood pressure, heart rate, and the requirement for ephedrine and serum sodium levels were recorded. Results: There was a rise in cardiac output readings at 5, 10 and 15 min in both groups, but Group P showed a significantly more rise compared to Group C after spinal anesthesia and compared with their baseline values. As for the systemic vascular resistance, a substantial drop occurred in Group P at 5, 10, and 15 min when compared to Group C, as well as when compared to their baseline levels. Except for considerably lower systolic blood pressure readings at 5 min after spinal block in Group P, in both groups, systolic blood pressure and heart rate changes were comparable. The median dose of ephedrine required for Group P patients was significantly greater. Conclusion: Hypertonic saline co-loading is more effective than its preloading in decreasing hypotension occurring with subarachnoid anesthesia for TURP surgery.

Page(s): 39-46

DOI: 10.35975/apic.v28i2.2213

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 28, Issue: 2, Year: 2024

Keywords:

preload , Hypertonic saline , TURP , Coload , Subarachnoid Anesthesia , Cardiometry

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