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• W2005299675 abstract "Editor—Dr Fonseca and colleagues1de Freitas Fonseca M Andrade Jr, CM de Mello MJE Crispi CP Effect of temperature on fluidity of irrigating fluids.Br J Anaesth. 2011; 106: 51-56doi:10.1093/bja/aeq303Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar have explored the effect of temperature on the fluidity of solutions used for irrigation of the bladder during endoscopy. They suggest, based on laboratory experiments, that cold solutions might be preferred since low temperature would cause less fluid absorption. I hope that no researcher attempts to investigate this issue in patients. Cold solutions have already been tried in the early 1960s and caused a 20% incidence of surgical complications, mostly fluid absorption, during resection of bladder cancer.2Franks DP Cockett AT Local hypothermia of the urinary bladder during transurethral surgery.Anesthesiology. 1961; 22: 15-19doi:10.1097/00000542-196101000-00004Crossref PubMed Scopus (7) Google Scholar Clinicians generally refrain from cold solutions because they increase the thermal loss during endoscopy.3Evans JW Singer M Coppinger SWV Macartney N Walker JM Milroy EJ Cardiovascular performance and core temperature during transurethral prostatectomy.J Urol. 1994; 152: 2025-2029Abstract Full Text PDF PubMed Scopus (24) Google Scholar Even modest hypothermia (1–2°C) makes the patient ‘feel cold’ and increases myocardial work and oxygen consumption due to vasoconstriction and even shivering. Fluid absorption makes things even worse as it further lowers (in particular) the rectal temperature,2Franks DP Cockett AT Local hypothermia of the urinary bladder during transurethral surgery.Anesthesiology. 1961; 22: 15-19doi:10.1097/00000542-196101000-00004Crossref PubMed Scopus (7) Google Scholar even when prewarmed solutions are used.4Hahn RG Cooling effect from absorption of pre-warmed irrigating fluid in transurethral prostatic resection.Int Urol Nephrol. 1993; 25: 265-270PubMed Google Scholar Fluid absorption occurs only during a minority of the time periods of surgery when the prerequisites for absorption are fulfilled, which consist of surgically opened veins and fluid pressure that exceeds the venous pressure.5Hahn RG Fluid absorption in endoscopic surgery (review).Br J Anaesth. 2006; 96: 8-20doi:10.1093/bja/aei279Abstract Full Text Full Text PDF PubMed Scopus (168) Google Scholar A sudden decrease in arterial pressure often occurs when absorption begins, which suggests that a haemodynamic change might initiate a ‘suctioning’ effect.6Hahn RG Ekengren J Patterns of irrigating fluid absorption during transurethral resection of the prostate as indicated by ethanol.J Urol. 1993; 149: 502-506Abstract Full Text PDF PubMed Scopus (93) Google Scholar Once started, fluid absorption does not stop until surgery ends. I have two suggestions for those who want to limit fluid absorption as an issue. Both are safer than the use of cold irrigating fluid. The first is to stop using glycine 1.5%. In numerous studies in animals and humans, glycine 1.5% has been shown to cause more tissue damage and symptoms than alternative fluids.7Yousef AA Suliman GA Elashry OS Elsharaby MD Elgamasy AE A randomized comparison between three types of irrigating fluids during transurethral resection in benign prostatic hyperplasia.BMC Anesthesiol. 2010; 10: 7doi:10.1186/1471-2253-10-7Crossref PubMed Scopus (37) Google Scholar 8Hahn RG Ethanol monitoring of irrigating fluid absorption (review).Eur J Anaesth. 1996; 13: 102-115doi:10.1097/00003643-199603000-00003Crossref PubMed Scopus (56) Google Scholar The second suggestion is to start monitoring fluid absorption with, for example, ethanol. This method is cheap, works well, and was fully evaluated 15 yr ago but has, as with the bad safety profile for glycine 1.5%, largely been disregarded by the medical community. The bipolar resection technique is probably an improvement but the issue is poorly studied at present. None declared." @default.
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• W2005299675 title "Cold irrigating fluids during endoscopy" @default.
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