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J O Hultén

Publications and source records attributed to J O Hultén.

7 recordsLinked to original sources
PubMed2002

How to master absorption during transurethral resection of the prostate: basic measures guided by the ethanol method.

OBJECTIVE: To evaluate the effect of basic measures to minimize the absorption of irrigating fluid during transurethral resection of the prostate (TURP) to the planned end-point, using the ethanol method to guide the surgeon. PATIENTS AND METHODS: Forty-six patients underwent TURP with intermittent irrigation using sterile water and 2% ethanol. The ethanol content in the expired breath of the patients was assessed every 5 min using a breath-alcohol monitor. In 25 patients no absorption was indicated but 21 showed some absorption according to the ethanol analyses. The operator was then immediately alerted, paused briefly to determine the route of absorption and to take advantage of blood clots to seal off leakage sites. On resuming the resection, attention was given to the pressure gradients in the operating field, based on bladder compliance and the flow in the irrigating jet. Repeated ethanol analyses were used to assess the result and to guide the surgeon's efforts. RESULTS: No operation had to be terminated prematurely; the mean absorption in the 21 patients in whom any ethanol was detected was 121 (75-230) mL. In 14 patients absorption occurred once, in six twice and in one there were three small absorption events. The group with absorption did not differ significantly from that with no absorption in operative duration (mean 48 and 47 min), resected weight (mean 32.8 and 31.6 g) or blood loss (mean 550 and 483 mL). CONCLUSION: If the surgeon is alerted at the first positive ethanol reading, effective measures to minimize absorption can be taken early. Regular use of the ethanol method as an alarm system should permit TURP with a minimum of absorption and avoid an early interruption or premature termination of surgery because of absorption.

Absorption↗
PubMed2000

The control of haemolysis during transurethral resection of the prostate when water is used for irrigation: monitoring absorption by the ethanol method.

OBJECTIVE: To determine whether the addition of ethanol to water for irrigation during transurethral resection of the prostate (TURP) and monitoring breath ethanol could be used to detect irrigant absorption and to limit free plasma haemoglobin in cases of absorption. PATIENTS AND METHODS: One hundred patients (46 in Piteå, Sweden and 54 in Uong bi, Vietnam) underwent surgery for benign prostatic hyperplasia (BPH) under an intermittent irrigation technique using water containing 2% ethanol. An expired breath alcohol meter was used to monitor ethanol in the patients' breath every 5 min. Blood samples taken after TURP were assessed for free haemoglobin in 99 patients, and other markers of haemolysis were also evaluated in the Swedish group. RESULTS: Thirty-two patients had detectable ethanol in their breath. There was a close correlation between the maximum ethanol reading during surgery and the level of free plasma haemoglobin after TURP (r = 0.90, P < 0.001). There was no correlation between the duration of TURP and the free haemoglobin level. CONCLUSION: Monitoring breath ethanol during TURP assesses absorption and so can help to keep control of haemolysis. It is suggested that the value on the alcohol meter should not be allowed to exceed 0.15 (corresponding to a blood ethanol level of 0.15 per thousand), which should maintain the free plasma haemoglobin level at < 1.0 g/L after TURP. Restricting the operative duration per se is not a reliable safety measure.

Absorption↗
PubMed1991

Absorption of irrigating fluid during TURP--fact and fiction.

The basic requirements for intravenous (IVA) and extravascular absorption (EVA) of irrigating solutions during TURP are discussed. The operating surgeon should not rely on thumb rules but know the mechanisms behind absorption and be acquainted with the inherent risks of his irrigating systems. Peroperative monitoring of absorption has obvious advantages for the patient's safety, for the anaesthetist and for the training surgeon. The use of ethanol as a tracer for the detection of irrigant absorption and the route of absorption is herein discussed. Some hints for limiting fluid absorption during TURP is also proposed.

Absorption↗
PubMed1990

Extravascular absorption of irrigating fluid during TURP. The role of transmural bladder pressure as the driving pressure gradient.

The critical intravesical pressure range for extravascular absorption of irrigating fluid (EVA) during transurethral resection of the prostate (TURP) is determined by the pressure in the perivesical tissue. This means that the transmural bladder pressure (detrusor pressure), calculated by deducting perivesical pressure from intravesical pressure during cystometry, is the pressure gradient behind EVA. The transmural pressure in 6 patients undergoing TURP has been studied both before and during epidural anaesthesia, using both conventional medium-fast fill cystometry and "free-flow" cystometry through the resectoscope. Epidural block does not influence the transmural pressure response on filling the bladder and neither does the type of infusion. A positive transmural pressure, and thereby a pressure gradient for EVA, exists already during the very early phase of bladder filling. Incomplete perforation of the prostatic capsule and clotting, as well as the accumulation of irrigating fluid in the perivesical tissue, probably moderate the rate of absorption.

Absorption↗
PubMed1989

Monitoring irrigating fluid absorption during transurethral resection of the prostate (TURP); a comparison between 1 and 2% ethanol as a tracer.

In a series of 35 transurethral resections of the prostate 1% ethanol was compared to 2% ethanol as a marker of the irrigating fluid. The ethanol concentration in the expired breath of the patient (EB-ethanol) correlated significantly to the irrigant absorption, as measured volumetrically, and to the change in the serum sodium concentration at 10-min intervals during the operation. The pattern of changes in EB-ethanol indicated whether the main part of the absorption entered through the intravenous or the extravascular route. With 1% ethanol added to the irrigating solution the absorption of 100-150 ml in 10 min could readily be detected. The sensitivity was twice as great with 2% ethanol; however, 1% ethanol is sufficient for routine procedures as it permits absorption to be detected long before it is large enough to produce a TUR syndrome. Monitoring ethanol in the expired breath provides the surgeon with an instrument to check that preventive steps against further absorption are effective.

Aged↗
PubMed1986

Monitoring fluid absorption during TURP by marking the irrigating solution with ethanol.

Ethanol has been evaluated as a marker of the irrigating fluid during TURP. In nine patients mannitol served as a reference substance (2% ethanol in 5% mannitol) and it could be verified that ethanol enters the body as a result of irrigating fluid absorption. Ethanol is instantly and easily demonstrated in the patient's expired breath with an Alcolmeter. In four healthy volunteers a 500 ml intravenous infusion of the irrigating fluid was given to imitate absorption. These experiments showed that very small amounts gave significant concentrations of ethanol in expired breath and that there was a distinct fall in expired ethanol as soon as the infusion was stopped. Thus marking the irrigating fluid with ethanol is a simple method which may be used to indicate absorption, to follow its course and to tell if preventive steps taken against further absorption are effective.

Absorption↗