Expired breath ethanol measurement to calculate irrigating fluid absorption during transurethral resection of the prostate: experience in a district general hospital.

Abstract

To estimate differences in the absorption of ethanol-tagged irrigant fluid in patients undergoing transurethral resection of the prostate (TURP) using measurements of ethanol concentration in the breath. The study comprised 100 randomly selected patients (mean age 71 years, range 38-85) undergoing TURP. At frequent intervals during TURP, the ethanol content of end-expiratory breath samples was measured using an alcometer, venous blood samples were drawn for determination of serum sodium, ethanol and haemoglobin concentration and the absorption of irrigant fluid and blood loss were estimated. These variables were compared between patients operated on by experienced and inexperienced surgeons. Ethanol was detected in the expired breath of 39 patients. Patients who absorbed irrigant fluid underwent longer operations than those who did not (median 33 min and 23 min, respectively; P < 0.01), had a greater weight of prostatic tissue resected (median 27.5 g and 16.5 g, respectively; P < 0.01) and lost more blood intra-operatively (median 295 mL and 143 mL, respectively; P < 0.01). Consultant urologists performed 75 of the operations, with 25 patients (33%) having detectable breath ethanol, and trainees carried out the remaining 25 operations, where 14 (56%) patients had ethanol detected in the expired breath. The difference in peak end-expiratory ethanol values between patients in the consultant and trainee group was significant (P < 0.0). Furthermore, the incidence of 'significant' irrigant fluid absorption, i.e. a peak breath alcohol > 300 mg/L (indicating > 1 L of irrigant absorption) was one patient (1.3%) from those operated upon by a consultant and four (16%) from those treated by a trainee (P < 0.05). Irrigant absorption occurs frequently during TURP and is more likely to occur in operations performed by trainee urologists.