[Sexuality following spinal anesthesia. A retrospective study of young men (less than 55 years old]. / Sexualität nach Spinalanästhesie. Eine Retrospektivbefragung bei jungen Männern (unter 55 Jahre).

A retrospective study was undertaken in order to determine whether the rumor that the use of spinal anesthesia in young men has a possible negative influence on sexual potency is justified or not. METHOD. Under the assumption that men up to the age of 55 years are generally sexually active, 1016 patients who were operated upon under spinal anesthesia (Ga. 22 and 25) during the last 5 years were requested to answer questions about their convalescence with emphasis on their pre- and postoperative sexual life. If they developed difficulties in this particular aspect, their opinion about the possible reasons was asked. RESULTS. Usable responses were obtained from almost 48% of the patients (Table 1). We excluded from the study those operations that could themselves have negatively influenced sexuality (Table 2). The patients belonged--as far as known--to ASA groups I-III (Fig. 2). Four-fifths of the patients had recovered completely 6 months after surgery (Fig. 4); their recovery was independent of the postoperative time interval (Table 1). Seventy-five percent were sexually active within 3 months after their operation (Fig. 6). There was no correlation between risk group and degree of recovery (Fig. 7, Tables 3 and 5). Nine of the preoperatively active patients did not have sex afterward, whereas 50% of the preoperatively inactive ones became active postoperatively (Tables 6 and 7). Four-fifths of the abstinent ones did not want sex or had no partner (Fig. 8). In no case was anesthesia mentioned as the cause of unwanted sexual abstinence (Fig. 9, Tables 3 and 4). Two patients who had resumed sexual activity but seemed dissatisfied with their sexual drive mentioned anesthesia as a possible cofactor in connection with surgery or psychological problems (Table 5). CONCLUSION. This is, as far as we know, the only study that has specifically investigated sexuality in relation to spinal anesthesia. The results show clearly that after uncomplicated, routine spinal anesthesia there is no negative influence on sexual potency. Nevertheless, should occasional difficulties with sexuality arise, spinal anesthesia does not have to be considered a primary causative factor.

[A clinical report of 11 years' experience of anesthesia for cesarean section (n = 721)--particularly spinal anesthesia (n = 648)--in a hospital outpatient clinic]. / Klinischer Erfahrungsbericht über 11 Jahre Kaiserschnittnarkosen (n = 721)--besonders Spinalanaesthesien (n = 648)--an einer Belegaussenklinik.

Experience with anesthesia for cesarean sections in a small obstetric and gynecology clinic attached to a general hospital is reported. The course of cases and the particular circumstances are described. During a period of 11 years 721 cesarean sections were performed, 643 (90%) under hyperbaric spinal anesthesia. The remaining operations were performed under general anesthesia. The distribution of elective and emergency cases to the different anesthetic methods is shown. In the early years size G22 needles where most frequently used, while later size G25 was used. The average extent of anesthesia with spinal anesthetic agents was to T 6.2 +/- 1.4. Some indications for intubation anesthesia and special features of spinal anesthetics are listed. The Apgar scores were 8.3 for 1 min and 9.5 for 5 min. In contrast to the patients operated on under general anesthesia, the majority of the patients treated during spinal anesthesia received (prophylactic) hypotensive treatment. There were no severe complications or deaths related to anesthesia. Some important points related to spinal anesthesia for cesarean sections are mentioned. The results show that with attention to detail and observation of correct procedures by qualified anesthetists, the vast majority of cesarean sections can be done very successfully under spinal anesthesia.

[Peak blood levels of mepivacaine following intravenous regional anesthesia using various concentrations]. / Spitzenblutspiegel von Mepivacain nach intravenöser Regionalanaesthesie (I.V.R.A.) bei Verwendung unterschiedlicher Konzentrationen.

In a previous study we assumed, that with I.V.R.A. the peak blood levels after opening the tourniquet would be less when lowering the concentration and simultaneously increasing the volume of the anesthetic solution. For supporting this hypothesis, on 17 patients each the peak blood levels of mepivacaine after I.V.R.A. were determined. For this a 0.25% (gr. A) and 0.50% (gr. B) concentration of solution was given. The same absolute amount (3.75 mg/ml b.w.) of the anesthetic was used and the measured values are compared. The results show a median for the 0.25% solutions of XA = 4,046 ng/ml and for the 0.50% ones of XB = 6,894 ng/ml. The values differ for p less than 0.05 with the onesided mediantest. Our initial assumption is confirmed which consequently contributes to greater safety.

[Prospective comparative study of postspinal headaches in young patients (less than 51 years)]. / Prospektiv vergleichende Studie postspinaler Kopfschmerzen bei jungen Patienten (less than 51 Jahre).

1.009 patients (less than 51 years) were investigated for the frequency of postspinal headaches developing when using different types of needles (22 G and 25 G with Quincke-cut and 22 G Whitacre-needle). It was shown, as expected, that puncture with the smaller needles caused with 6% only about half as many headaches as did taps with the two bigger types of needles, which did not demonstrate any statistical difference between each other. After classifying the complaints as doubtful and definite postspinal headaches the rates of real headaches of the total series was about 5%. The highest frequency of complaints was reported by female patients in the 5th decade. An increase with lesser age was not noticed. Technical difficulties associated with spinal puncture were of almost no importance in influencing the rate of headaches. Definite bloody taps were associated with significantly higher complaint rates. The drugs used (mepivacaine and bupivacaine) did not appear to have any influence. An advantage of the more expensive Whitacre-needle is not seen except in patients with disturbances of coagulation factors.

[Clinical aspects of intravenous regional anaesthesia (I.V.R.A.) (author's transl)]. / Klinische Gesichtspunkte zur intravenösen Regionalanaesthesie (I.V.R.A.).

3 groups of patients undergoing upper extremity surgery were anaesthetized with I.V.R.A. They were prospectively investigated to determine their absolute need of drug and the failure rate. As anaesthetics 0.50%, 0.33% and 0.25% mepivacaine solutions were used. It was found that the reduction in concentration with a combined increase in volume leads to a higher success rate and a simultaneous reduction of the absolute amount of drug. It is recommended to use 1.0-1.5 ml/kg b.w. of the 0.25% solution. If there are scars, adhesions as well as marked swellings at the operative site, it is advised not to use I.V.R.A. because of the greater risk of failure. The low postanaesthetic tendency for swelling and the extension of the operative site to the distal third of the upper arm are additionally stressed. Clinically relevant side effects were not observed.

[Experiences with hyperbaric bupivacaine solutions in spinal analgesia (author's transl)]. / Erfahrungen mit hyperbaren Bupivacain-Lösungen in der Spinalanaesthesie.

Spinalanaesthesia with hyperbaric bupivacaine (0.4%, 1.0%, 0.5%) was used in 713 patients having general surgical and urological operations. On average 19.30 +/- 1.55 mg bupivacaine was given and a spread of anaesthesia up to Th 7.21 +/- 1.55 achieved. Detailed evaluation of the 3rd group (0.5%) showed a latency period of 2.21 +/- 0.82 min and mean effective time of 4.33 +/- 0.75 h. The motor blockade was in 87% complete. The problem of the 0.5% solution with a specific gravity of 1.037 g/ml, which is in our opinion too high, was pointed out and a recommendation for a specific gravity of about 1.020 g/ml was given. Assuming proper positioning, spinal anesthesia with hyperbaric bupivacaine is a safe and simple anaesthetic method.

[Clinical trial of bupivacaine-CO2 (author's transl)]. / Klinische Erprobung von Bupivacain-CO2.

One hundred and forty-one patients for general and urological surgery were anaesthetized by epidural anesthesia (PDA) using bupivacaine-CO2 0.5% solutions. A frequency peak for the initial dose between 21-23 ml was noted. The response time and latency period were found to be 2.99 +/- 1.40 min and 11.02 +/- 3.66 min (smallest time unit 0.5 min). The effective duration was 5.02 +/- 0.93 h. The sensory spread reached on average to T 6.06 +/- 1.41 segments for the patients with typical injection locations at L2/3-L4/5. A mean dose of 6.25 +/- 0.18 mg per spinal segment was used. Side effects were not seen apart from occasional hypotension. The failures were not related to the anesthetic drug. The degree of muscle relaxation was for the majority of cases evaluated at 2 +, which was sufficient for the abdominal operations. The results are compared with the data obtained using bupivacaine-HC1; the advantages of bupivacaine-CO2 are described.