An 85-year-old man with COPD and CAD undergoes transurethral resection of the prostate under spinal anesthesia. Twenty minutes into the procedure, he becomes restless and hypertensive, with bradycardia and dyspnea. The most likely cause is

An 85-year-old man with COPD and CAD undergoes transurethral resection of the prostate under spinal anesthesia. Twenty minutes into the procedure, he becomes restless and hypertensive, with bradycardia and dyspnea. The most likely cause is

• A. Volume overload
• B. Hyponatremia
• C. High spinal
• D. Bladder perforation

Answer: (A)

Absorption of the irrigation fluid used during TURP can overwhelm the patient’s circulation, especially in an elderly person with COPD and CAD. When irrigation fluid enters the venous system, it creates acute volume overload (hypervolemia). This sudden rise in intravascular volume commonly leads to pulmonary edema, which explains the dyspnea, and tends to raise blood pressure. The restlessness can reflect CNS effects from fluid shifts and, in some cases, hyponatremia from the dilutional effect of the fluid, but the combination of dyspnea with hypertension and a reflex-like bradycardia fits fluid overload from irrigation absorption most closely. A high spinal would more likely cause hypotension with bradycardia; hyponatremia would produce more prominent CNS symptoms and seizures rather than acute pulmonary edema; bladder perforation would present with abdominal pain and peritoneal signs rather than this respiratory–cardiovascular picture.

Absorption of the irrigation fluid used during TURP can overwhelm the patient’s circulation, especially in an elderly person with COPD and CAD. When irrigation fluid enters the venous system, it creates acute volume overload (hypervolemia). This sudden rise in intravascular volume commonly leads to pulmonary edema, which explains the dyspnea, and tends to raise blood pressure. The restlessness can reflect CNS effects from fluid shifts and, in some cases, hyponatremia from the dilutional effect of the fluid, but the combination of dyspnea with hypertension and a reflex-like bradycardia fits fluid overload from irrigation absorption most closely. A high spinal would more likely cause hypotension with bradycardia; hyponatremia would produce more prominent CNS symptoms and seizures rather than acute pulmonary edema; bladder perforation would present with abdominal pain and peritoneal signs rather than this respiratory–cardiovascular picture.