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

Labs and studies

Operating room setup

Patient preparation and premedication

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[1]

Emergence

Postoperative management

Disposition

  • PACU

Pain management

Potential complications

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

References

  1. "Total intravenous general anesthesia with laryngeal mask airway for transurethral resection of bladder tumor". Journal of Medical Colleges of PLA. 22 (4): 234–237. 2007-08-01. doi:10.1016/S1000-1948(07)60047-1. ISSN 1000-1948.