Canadian Journal of Anesthesia, Vol 16, 217-224, Copyright © 1969 by Canadian Anesthesiologists' Society

Bleeding during Transurethral Prostatic Surgery

¹ Department of Anaesthesia, University of Toronto and Toronto General Hospital

Many factors influence bleeding during transurethral prostatic surgery. Some of these are unavoidable, while others can be avoided or corrected if the patient is carefully monitored by the anaesthetist. In many instances the resectionist can be given early warning of changes which are occurring so that he may bring the operation to an end.

Direct measurements of blood loss during transurethral prostatic surgery has proved invaluable, particularly in avoiding circulatory overload due to excessive blood transfusion. We have described a method of measuring blood loss which has proved practical as a routine operating room procedure.

Any factor which raises venous pressure will lead to haemorrhage during transurethral prostatic surgery. These include straining during general anaesthesia, shivering during spinal anaesthesia, and circulatory overload by absorption of irrigating fluid or excessive transfusion. The usefulness of careful monitoring of the central venous pressure has been clearly shown.

General anaesthesia for transurethral prostatic resection must be deep enough to produce absolute analgesia and to prevent contraction of the abdominal muscles during the resection. Shivering must be avoided under spinal anaesthesia, since this raises the venous pressure and increases haemorrhage. The use of vasopressors must also be avoided.

Resection time should be limited to one hour, since there is a disproportionate increase in blood loss after that time.