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General Article
Anesthesia and Pain Medicine 2008;3(2):154-156.
Published online April 30, 2008.
Penile Erection during Transurethral Surgery : Case report and review of the literature
Young Ju Won, Jeong Yeon Hong
Department of Anesthesiology and Pain Medicine, Anesthesiology and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.,
Imbalance between sympathetic and parasympathetic nervous systems is generally considered an underlying mechanism for intraoperative erection, although local stimulation before complete sensory blockade can contribute to the problem. With the onset of erection under regional anesthesia during an operative procedure, general inhalational anesthesia must be quickly initiated to enhance venous drainage of the engorged corpora cavernosa before prolonged venous stasis. Combination therapy including ketamine, glycopyrrolate, terbutaline, and alpha-adrenergics may be available, however, the benefit-risk ratio should be considered especially in the elderly patients with cardiovascular diseases. We present a case of intraoperative erection in an elderly patient, which was resolved by applying inhalational anesthesia with remifentanil after confirmation ineffectiveness of intravenous glycopyrrolate and ketamine. We also review and discuss the treatment strategies.
Key Words: general anesthesia, intraoperative, penile erection, transurethral procedure
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