Transurethral resection of bladder tumor

Transurethral resection of bladder tumor

Anesthesia type	GA or Neuraxial
Airway	ETT/LMA (if GA)
Lines and access	PIV x 1
Monitors	Standard
Primary anesthetic considerations
Preoperative
Intraoperative	Muscle relaxation may be requested by surgeon
Postoperative
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A transurethral resection of bladder tumor (TURBT) is an endoscopic procedure used to diagnose, stage, and treat early tumors of the bladder. A resectoscope is passed into the bladder via the urethra and used to remove visible tumor.

Preoperative management

Patient evaluation

System	Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Regional and neuraxial techniques

• Can be performed under spinal anesthesia
  • Spinal anesthesia will not eliminate

Intraoperative management

Monitoring and access

• PIV x1

Induction and airway management

• If GA, ETT vs. LMA
  • Surgeon may request sustained muscle relaxation to limit movement from obturator nerve stimulation

Positioning

• Lithotomy

Maintenance and surgical considerations

• Stimulation of the obturator nerve can cause significant movement, which creates risk of bladder perforation
  • Risk increased if tumor involves lateral wall of the bladder
  • To avoid this reflex, muscle relaxation is often used
• However, studies have shown that TIVA with LMA is a safe, reliable, and controllable method for maintenance of anesthesia with blunting of the obturator reflex

Postoperative management

Disposition

• PACU

Potential complications

• Bladder perforation (most serious complication)
• Urethral rupture or false passage
• Bleeding
• Reabsorption