COAGULOPATHIES IN PATIENTS AFTER TRANSURETHRAL RESECTION OF THE PROSTATE - SPINAL VERSUS GENERAL-ANESTHESIA

This prospective, randomized study evaluated the effects of spinal ver sus general anesthetic technique on perioperative blood loss and the d evelopment of postoperative coagulopathies in 50 patients undergoing t ransurethral resection of the prostate (TURP). Preoperative hematologi c measurements included hemoglobin, platelet count, electrolytes, prot hrombin time, partial thromboplastin time, fibrinogen, factor V, plasm inogen, antithrombin III, and fibrinogen degradation product (FDP) lev els. All hematologic blood samples were repeated postoperatively at 1, 6, and 24 h. Intraoperative blood loss was not significantly differen t between the spinal and general anesthesia groups. The total blood lo ss after TURP was significantly correlated (r = 0.76; P < 0.0001) with the prostatic tissue weight. When the tissue weight resected exceeded 35 g, blood loss was in excess of the linear correlation shown with t he weight of resected prostatic tissue. Platelet count decreased and p rothrombin time increased in the spinal group at all postoperative tim e intervals compared to preoperative value (P < 0.05). There was no si gnificant difference in measured coagulation variables (fibrinogen, fa ctor V,plasminogen, antithrombin III, and FDP) between the spinal and general anesthesia groups, but there were significant decreases in pos toperative fibrinogen and Factor V levels compared to preoperative val ues in both spinal and general anesthesia groups. Three patients (6%) had increased FDP levels 1 h postoperatively. The prostatic tissue wei ght and the surgical duration was significantly higher in these patien ts. We conclude that perioperative blood loss in TURP patients is not affected by the anesthetic technique. However, 6% of TURP patients dev eloped subclinical intravascular coagulopathies which correlated with mass of resected prostate tissue.