ANESTHESIA FOR ENDOSCOPIC LASER-SURGERY FOR PROSTATE USING MAGNETIC-RESONANCE-IMAGING

The anaesthetic management of eight patients aged between 58 and 76 ye ars undergoing laser prostatic surgery in a magnetic resonance imaging (MRI) scanner and the problems presented by the magnetic field and th e working environment are discussed. The advantages of this type of su rgery are better haemostasis and a reduction in the TURF syndrome. Two were managed with general anaesthesia and spontaneous respiration usi ng a thiopentone N2O/O-2 isoflurane sequence. Six remained conscious d uring regional anaesthesia with combined spinal/epidural analgesia and oxygen therapy, and did not require sedation. The duration of anaesth esia varied between 85 and 165 min (mean 110 min) and three patients r equired an epidural top-up after 80-100 min. One patient with a histor y of angina developed chest pain and raised cardiac enzymes 5 h after the procedure which was otherwise uneventful. Monitoring the ST segmen t in a magnetic field is inaccurate, and the research protocol now exc ludes patients with significant ischaemic heart disease.