Inferior Vena Cava Diameter Dependent Colloid Challenge Versus Routine Crystalloid Strategy Transurethral Resection Prostate
Condition: Volume Overload
Study type: Interventional

Summary: 
      Background: Intravenous fluid replacement during transurethral resection of the prostate is
      still unclear. Ultrasonography of the inferior vena cava (IVC) has been recently used to
      assess the volume status and predict fluid responsiveness. In this double-blind, randomized
      controlled study, we will assess the IVC at baseline and at subsequent time points after
      spinal anesthesia, and according to IVC diameter will give the replacement challenge colloid.
      Potential problems during TURP are mostly due to either fluid overload or bleeding:
      Intraoperative TURP syndrome, Hemorrhage, Myocardial ischemia, Hypothermia, Prostatic
      capsular perforation, Bladder or urethral perforation. Postoperative TURP syndrome,
      myocardial ischemia/infarction, Postoperative cognitive impairment. Study Hypothesis: Strict
      colloid volume optimization using US-guided IVC diameter calculation aiming decrease the
      total IV fluid volume and accommodate the transurethral inevitable absorption of currently
      used irrigation crystalloid fluid (Nacl0.9%) that accidentally absorbed and change it from a
      circulatory overload to a complementary part of the replacement IV fluids preventing fluid
      overload and TURP syndrome. Aim of the work: To reduce Intraoperative and postoperative fluid
      overload during TURP surgery with hemodynamic stability relaying up on US-guided IVC diameter
      dependent Strict IV Colloid replacement volume optimization. Methods: A prospective
      randomized controlled trial on ASAI-III male patient aged 40-80 years old subjected to
      transurethral endoscopic resection of the prostate (TURP) surgery. Then patients will be
      divided into 2 groups according to the IV infusion fluid type as follow: Crystalloid -control
      group: (preload plus continuous IO Ringer acetate crystalloid 4/2/1 rule infusion) according
      to the usual 4/2/1 rule. Not guided by IVC diameter but IVC diameter will be calculated using
      the US and recorded at baseline just after spinal anesthesia and then every 30 minutes till
      the end of surgery. Loop Diuretic (Furosemide) will be given according to the maximum
      diameter of the IVC as follow; 10mg if IVC>2.5Cm. Colloid- study group: (preload plus colloid
      challenge only); Fluid challenge boluses of 250 mL (over 5 minutes using a pressurizer) 6%
      hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (voluven®) if the IVC<1.7(higher limit of
      normal) will be given guided by IVC diameter at baseline just after spinal anesthesia and
      then every 30 minutes till the end of surgery.
    


Intervention name(s): Ultrasound-guided Inferior vena cava diameter dependent colloid challenge versus routine crystalloid strategy Fluid replacement
Intervention type(s): Other
Intervention description(s): The inferior vena cava largest and smallest diameters will be measured proximal to the opening of the hepatic veins in the longitudinal axis with the M-mode using a 8-2 MHz curved array ultrasound probe placed longitudinally in the subcostal region.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care