DOES SPINAL-ANESTHESIA AFFECT CEREBRAL OXYGENATION DURING TRANSURETHRAL PROSTATECTOMY

Background and Objectives. Transurethral resection of the prostate (TU RP) is associated with the unique complication of transurethral resect ion of prostate syndrome (TURS), which is attributed to the absorption of irrigating fluid. This study was initiated to investigate the effe cts of spinal anesthesia and TURF on cerebral oxygen balance. Methods. Thirty patients scheduled for TURF were included. Jugular bulb oxygen saturation (SjbO2) was measured via retrograde cannulation of jugular venous bulb. Spinal anesthesia was initiated by 3 mL hyperbaric 0.5% bupivacaine injected at L3-L4 in the sitting position, producing a blo ck to the Tin dermatome. Hemodynamic measurements and arterial and jug ular bulb blood gasometry were performed before and after spinal anest hesia, throughout surgery, and during the postoperative period. Result s. A significant decrease of cerebral perfusion pressure after spinal anesthesia was accompanied by a significant decrease of SjbO2 below a preoperative value of 61% +/- 1. Eight patients developed yawning, irr itability, restlessness, and nausea toward the end of surgery, and the se were considered to be early signs of TURS. These patients demonstra ted SjbO2 below 55% and 50% in 63% and 42% of respective data set poin ts. Conclusion. The neurologic symptoms in patients undergoing TURF du ring spinal anesthesia might not only be caused by absorption of irrig ating fluid but also by impairment of cerebral oxygenation.