01.12.2015 | Research article | Ausgabe 1/2015 Open Access

Change in serum sodium level predicts clinical manifestations of transurethral resection syndrome: a retrospective review
- Zeitschrift:
- BMC Anesthesiology > Ausgabe 1/2015
Competing interests
Authors’ contributions
Background
Methods
Severity score
|
1
|
2
|
3
|
---|---|---|---|
Circulatory
|
|||
Chest pain
|
Duration < 5 min
|
Duration > 5 min
|
Repeated attacks
|
Bradycardia
|
HR decrease 10–20 bpm
|
HR decrease > 20 bpm
|
Repeated decreases
|
Hypertension
|
SAP up 10–20 mmHg
|
SAP up > 30 mmHg
|
Score (2) for 15 min
|
Hypotension
|
SAP down 30–50 mmHg
|
SAP down > 50 mmHg
|
Repeated drops > 50 mmHg
|
Poor urine output
|
Diuretics needed
|
Repeated use
|
Diuretics ineffective
|
Neurological
|
|||
Blurred vision
|
Duration < 10 min
|
Duration > 10 min
|
Transient blindness
|
Nausea
|
Duration < 5 min
|
Duration 5–120 min
|
Intense or > 120 min
|
Vomiting
|
Single instance
|
Repeatedly, < 60 min
|
Repeatedly, > 60 min
|
Uneasiness
|
Slight
|
Moderate
|
Intense
|
Confusion
|
Duration < 5 min
|
Duration 5–60 min
|
Duration > 60 min
|
Tiredness
|
Patient says so
|
Objectively exhausted
|
Exhausted for > 120 min
|
Consciousness
|
Mildly depressed
|
Somnolent < 60 min
|
Needs ventilator
|
Headache
|
Mild
|
Severe < 60 min
|
Severe > 60 min
|
Results
Parameter
|
Symptomatic (n = 60)
|
Asymptomatic (n = 169)
|
Pvalue
|
---|---|---|---|
Age, yr
|
72 ± 8
|
70 ± 7
|
0.146
|
Height, cm
|
164.6 ± 6.2
|
164.8 ± 6.0
|
0.788
|
Body weight, kg
|
62.9 ± 10.0
|
63.2 ± 9.5
|
0.862
|
Diabetes mellitus
|
4 (66.7%)
|
11 (6.5%)
|
1.000
|
Hypertension
|
6 (10.0%)
|
14 (8.3%)
|
0.395
|
Arrhythmia
|
1 (1.7%)
|
1 (0.6%)
|
0.456
|
Preoperative blood data
|
|||
Creatinine, mg/dl
|
0.9 ± 0.2
|
0.9 ± 0.2
|
0.861
|
BUN, mg/dl
|
16.6 ± 6.1
|
15.7 ± 4.1
|
0.619
|
Sodium, mmol/l
|
140.8 ± 2.1
|
140.7 ± 2.3
|
0.963
|
Hemoglobin, g/dl
|
13.6 ± 1.5
|
14.0 ± 1.5
|
0.078
|
Estimated prostatic grand size, g
|
87.8 ± 41.8
|
64.9 ± 26.6
|
<0.001
|
Parameter
|
Symptomatic (n = 60)
|
Asymptomatic (n = 169)
|
Pvalue
|
---|---|---|---|
Continuous irrigation fluid drainage
|
23 (38.3%)
|
16 (9.5%)
|
<0.001
|
0.5% Bupivacaine, ml
|
2.5 ± 0.4
|
2.5 ± 0.3
|
0.117
|
Resection weight, g
|
47.5 ± 29.6
|
31.1 ± 20.0
|
<0.001
|
Operation time, min
|
108 ± 35
|
85 ± 35
|
<0.001
|
Infusion volume, ml
|
909 ± 508
|
635 ± 346
|
<0.001
|
Infusion and transfusion volume, ml
|
1107 ± 609
|
697 ± 385
|
<0.001
|
Diuretics
|
7 (11.7%)
|
1 (0.6%)
|
<0.001
|
Sodium chloride
|
1 (1.7%)
|
0 (0.0%)
|
0.143
|
Symptoms
|
60 (100.0%)
|
-
|
NA
|
Restlessness
|
28 (46.7%)
|
-
|
NA
|
Vomiting
|
22 (36.7%)
|
-
|
NA
|
Nausea
|
36 (60.0%)
|
-
|
NA
|
Pain
|
17 (28.3%)
|
-
|
NA
|
Confusion
|
13 (21.7%)
|
-
|
NA
|
Postoperative blood data
|
|||
Creatinine, mg/dl
|
0.9 ± 0.3
|
0.9 ± 0.2
|
0.774
|
BUN, mg/dl
|
12.9 ± 5.2
|
13.0 ± 4.0
|
0.368
|
Sodium, mmol/l
|
134.8 ± 6.8
|
138.2 ± 3.4
|
<0.001
|
Hemoglobin, g/dl
|
11.0 ± 1.8
|
12.7 ± 1.6
|
<0.001
|
Operative and postoperative blood data
|
|||
Minimum hemoglobin, g/dl
|
10.8 ± 2.0
|
12.4 ± 1.9
|
<0.001
|
Minimum sodium, mmol/l
|
125.2 ± 10.5
|
136.9 ± 4.5
|
<0.001
|
Minimum sodium ≤125 mmol/l
|
29 (48.3%)
|
5 (3.0%)
|
<0.001
|
Change in sodium level, mmol/l
|
14.9 ± 10.3
|
3.8 ± 4.5
|
<0.001
|
Percent change in sodium level, %
|
10.6 ± 7.3
|
2.7 ± 3.2
|
< 0.001
|
Parameter
|
P value
|
Odds ratio
|
95% Conficdence interval
|
Hosmer-Lemeshow test
|
|
---|---|---|---|---|---|
P value
|
Accuracy
|
||||
Set1
|
0.168
|
86.0%
|
|||
Resected weight≧46 g
|
0.944
|
1.03
|
0.41 to 2.59
|
||
Operating time≧90 min
|
0.006
|
3.31
|
1.40 to 7.82
|
||
Minimum sodium ≦125 mmol/l
|
<0.001
|
34.66
|
11.77 to 102.06
|
||
Continuous irrigation fluid drainage
|
<0.001
|
9.62
|
3.72 to 24.89
|
||
Set2
|
0.044
|
81.1%
|
|||
Resected weight≧46 g
|
0.664
|
0.82
|
0.33 to 2.04
|
||
Operating time≧90 min
|
0.024
|
2.61
|
1.13 to 6.03
|
||
Change in sodium level ≧7 mmol/l
|
<0.001
|
14.76
|
6.66 to 32.72
|
||
Continuous irrigation fluid drainage
|
<0.001
|
6.08
|
2.29 to 16.15
|
||
Set3
|
0.042
|
81.6%
|
|||
Resected weight≧46 g
|
0.968
|
0.98
|
0.40 to 2.41
|
||
Operating time≧90 min
|
0.015
|
2.77
|
1.22 to 6.29
|
||
Percent change in sodium level≧7%
|
<0.001
|
15.36
|
6.82 to 34.58
|
||
Continuous irrigation fluid drainage
|
<0.001
|
6.90
|
2.65 to 17.92
|
Cutoff value
|
AUC
|
Sensitivity
|
Specificity
|
Pvalue
|
|
---|---|---|---|---|---|
Change in serum sodium
|
7.4 mmol/l
|
0.87
|
0.72
|
0.87
|
< 0.001
|
Percent change in serum sodium
|
7.0%
|
0.87
|
0.70
|
0.89
|
< 0.001
|