[Anesthesia in transurethral surgery]. / Die Anästhesie in der transurethralen Chirurgie.

Transurethral resection (TUR) is a surgical operation generally performed in elderly patients, afflicted with polymorbidity and a high risk for anaesthesia. We studied 1351 transurethral resections during the years 1974-1984: 840 of these procedures were done under regional block--spinal as well as epidural--and 511 in general anaesthesia. Results and complications were related to the applied technique of anaesthesia. Considering that especially the very old patients belong to the regional anaesthesia group where general anaesthesia is known to be dangerous, the results of this study confirm definitely that regional anaesthesia is at present the most appropriate technique for TUR surgery.

[Met-Hb formation and local anesthesia using bupivacaine, carticaine and etidocaine (author's transl)]. / Haemiglobinspiegel unter Lokalanaesthesie mit Bupivacain, Carticain und Etidocain.

Hemoglobin-(= Met-Hb)formation by local anaesthesia and local anaesthetics is still a point for discussion. Until now met-hb-aemia only was proven to develop under local anaesthetics with relationship to aniline (Benzocaine, Citanest). Since aniline does not possess any oxidative properties, met-hb-formation only can occur after metabolism (phenylhydroxylamine or para-aminophenol), first of all amino- and nitro-groups [6, 14] will be made responsible for oxidation. Because of the fact that neither the relationship to aniline nor the benzol-structure is the pre-supposition for met-hb-formation, possibly other substances with amino- or nitro-groups may induce it. In consequence of incidental cyanosis under intra and extradural analgesia we studied the met-hb-behaviour after the use of different local anaesthetics. The aniline-related bupivacaine and etidocaine were opposed to the thiophene-related carticaine. In this examination we found neither an elevation of hemoglobin by the aniline-related nor by the thiophene-related substances.

[Methaemoglobin-behaviour due to carticaine (= Ultracain) (author's transl)]. / Methaemoglobinverhalten unter Anwendung von Carticain (= Ultracain).

The influence of carticaine on the formation of methaemoglobin was investigated in 22 patients undergoind spinal (n = 10) or epidural (n = 12) anaesthesia. Carticaine in a dose of 1,35 mg/kg, as used for spinal anaesthesia, did not influence the concentration of methaemoglobin. Carticaine in a dose of 5 mg/kg however, as used for epidural anaesthesia, increased the formation of methaemoglobin slightly at 30 min after injection. This increase is of little clinical importance since the upper limits of the normal range were not reached.

[Serum electrolytes during neuroleptic analgesia and spinal anaesthesia (author's transl)]. / Serumelektrolyte während Neuroleptanalgesie und Lumbalanaesthesie

Spinal anaesthesia is particularly suitable for operations on the prostate in geriatric patients. We investigated the effects of spinal anaesthesia, using Bupivacaine 0.5%, on electrolyte metabolism in 12 patients and compared these with the effects of neuroleptanalgesia in 13 patients. Neuroleptanalgesia did not affect electrolytic concentrations, whereas spinal anaesthesia was associated with a temporary slight fall in potassium concentration.