Another important complication resulting from massive systemic absorption of irrigation fluids is coagulopathy. An in vitro study conducted by Shin et al. [2], published in this issue of the Korean Journal of Anesthesiology, investigated the effect of irrigation using a sorbitol-mannitol mixture on coagulation using rotational thromboelastometry (ROTEM) at different levels of hemodilution. They demonstrated that increasing hemodilution resulted in impaired coagulation. Interference with clot stabilization with fibrin polymerization may be responsible for the impairment of coagulation. A decrease in the serum level of coagulation factors due to hemodilution may also lead to impaired coagulation during TURP [3]. Considering these factors, the coagulation status should be checked if a large volume of irrigation fluid is used with a likelihood of significant systemic absorption. Besides, intraoperative hemorrhage may also contribute to consumption coagulopathy.

In conclusion, it is important for anesthesiologists to be aware of complications resulting from the systemic absorption of irrigation fluids during TURP. ROTEM as a point-of-care tool may be helpful in the assessment of clotting function and early detection of a coagulopathic state when massive absorption of irrigation fluids accompanied by intraoperative hemorrhage is suspected.