During transurethral resection of the prostate under spinal anaesthesia, a patient becomes restless and confused, then bradycardic and hypotensive. Serum sodium is 118 mEq/L. What is the FIRST step in management?

• A Give 3% hypertonic saline immediately
• B Stop the procedure and discontinue bladder irrigation ✓
• C Administer furosemide 40 mg IV
• D Intubate and commence mechanical hyperventilation

Explanation

TURP syndrome results from systemic absorption of hypotonic irrigation fluid through open prostatic venous sinuses, causing dilutional hyponatraemia and hypo-osmolality with volume overload. The immediate action is to halt the operation and stop irrigation, terminating further absorption. Hypertonic saline is reserved for symptomatic severe hyponatraemia after absorption has stopped, furosemide addresses volume overload later, and hyperventilation plays no role. Early recognition under regional anaesthesia depends on watching for restlessness and confusion.

Reference: Miller's Anesthesia, 9th ed.

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