Anesthetic Considerations for Urologic Surgeries

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The obturator nerve running close to the lateral wall of the bladder may be stimulated during TURB, which may result in obturator nerve reflex and unpredictable movement of the ipsilateral thigh. (View Highlight)
deep NMB significantly increased optimal surgical condition and decreased the incidence of obturator nerve reflex compared to moderate NMB (View Highlight)
The bladder consists of smooth muscles where NMB agents are ineffective. Therefore, it is inferred that full relaxation of surrounding muscles, including the pelvis and abdomen, could enhance surgical conditions. (View Highlight)
spinal anesthesia could not prevent obturator nerve reflex, and obturator nerve block (ONB) is required to prevent obturator nerve reflex. (View Highlight)
adverse events related to the use of irrigating fluids may occur in patients undergoing TURP (View Highlight)
Venous sinus exposure and prostatic capsule injury allow the absorption of irrigating fluid in the body. The absorbed irrigating fluid can cause acute change in the intravascular volume, electrolyte concentration, and osmolality, which leads to complications such as fluid overload, pulmonary edema, hyponatremia, and coagulopathy. Additionally, the additives of irrigating fluid, such as glycine and sorbitol, are metabolized to ammonia, which may induce tremor or seizure. This phenomenon is called TURP syndrome. (View Highlight)