Conivaptan prophylactically in transurethral resection of prostate surgeries

Abstract

Background Transurethral resection of prostate (TURP) requires the use of irrigating fluids. The absorption of large volumes of these fluids may lead to hyponatremia and consequently TURP syndrome. If not treated promptly, the patient becomes cyanotic, hypotensive, and ultimately sustains cardiac arrest. Conivaptan is one of vaptans, a new group of vasopressin receptor antagonists that are increasingly being used for the treatment of euvolemic, hypervolemic forms of hyponatremia especially in the ICU. This study evaluates the efficacy of a single dose of conivaptan to prevent hyponatremia in TURP patients. Patients and methods In a prospective, randomized, double-blinded study, 50 male patients scheduled for elective TURP under central neuraxial block were included in this study. Patients were divided into two groups (A and B) (n=25 for each group). Group A patients received intravenous conivaptan 20 mg over 30 min, whereas group B was the control group who received the usual maintenance fluid. Preoperative serum sodium and potassium levels in patients were measured, followed by intraoperative levels, and these levels were recorded after 60 min by blood gas analyzer using venous blood samples. All patients were carefully observed for the early symptoms of TURP syndrome perioperatively. The serum levels of sodium and potassium of all patients were measured 1 h after surgery. Results The mean level of serum sodium showed statistically significant reduction (hyponatremia) intraoperatively and postoperatively in group B. There was a statistically insignificant increase in the mean level of serum potassium (hyperkalemia) intraoperatively and postoperatively in both groups. Electrolyte changes were asymptomatic clinically. Conclusion A single dose of conivaptan was found to be effective in preventing a marked decrease in the serum sodium levels in patients undergoing TURP with no effect on the serum potassium level.