Bladder Distension Precipitates Severe Bradycardia Under Spinal Anaesthesia
Published on: 2016-05-16
Bladder distension with increased intravesical pressure during transurethral resection of the prostate (TURP) and bladder tumours (TURBT) under spinal anaesthesia occurs frequently and unintentionally. It may precipitate significant harmful effects especially to patients suffering from compromised cardiovascular functions. The establishment of the sympatholytic effects and overriding parasympathetic effects following the introduction of a spinal anaesthetic block (SAB) can disturbs the balanced functions between the two components of the autonomic nervous system. The precise establishment of SAB, adequate hydration, intimate monitoring, positioning of the patient and strict availability of resuscitation drugs are crucial precautionary aspects to monitor during this procedure. Optimizing the surgical conditions regarding: the bladder volume, intravesical pressure, height of the irrigating fluid and duration of the resection are all of paramount importance to prevent any untoward events. Here is a presentation of two cases that suffered from severe bradycardia and hypotension during TURP under spinal anaesthesia with discussion of the possible causes; emphasizing the effects of bladder distension during the procedures. Verbal consent for the presentation and publication of these case reports was kindly given by both patients.