C Neuhäuser

Justus-Liebig-Universität Gießen, Gieben, Hesse, Germany

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Publications (26)62.95 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: We examined the hypothesis that major cardiac surgery triggers a more intense adrenal stress response than less intensive noncardiac surgery, which then alters cortisol inactivation. Urinary excretion rates of glucocorticoid metabolites were determined before and after surgery using gas chromatography-mass spectrometry in 29 children undergoing scheduled major cardiac surgery and 17 control children undergoing conventional noncardiac surgery in a prospective observational study. Excretion rates of glucocorticoid metabolites were summed and corrected for creatinine excretion to calculate cortisol production rates (mg/mmol creatinine/m(2) body surface area). Precursor/product ratios from individual metabolites were calculated to characterize cortisol inactivation (11β-hydroxysteroid dehydrogenase). Postoperatively, median cortisol production rates increased in both groups (MCS: from 2.7 to 9.3; controls: from 2.7 to 5.8; p<0.001) with no significant difference between groups (p=0.12). Ratios of cortisol to cortisone metabolites, indicating the overall activity of 11β-hydroxysteroid dehydrogenase, increased postoperatively in both groups (p<0.001). In conclusion, surgery resulted in a distinct postoperative increase in cortisol production. In contrast to our hypothesis, children undergoing major cardiac surgery did not show an increased adrenal stress response compared to children undergoing conventional surgery. Furthermore, the reduction in cortisol inactivation appears to be an essential part of the stress response to pediatric surgery in general.
    Hormone and Metabolic Research 05/2014; 46(10). · 2.04 Impact Factor
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    ABSTRACT: While the neuroprotective benefits of estrogen and progesterone in critical illness are well established, the data regarding the effects of androgens are conflicting. Surgical repair of congenital heart disease is associated with significant morbidity and mortality, but there are scant data regarding the postoperative metabolism of sex steroids in this setting. The objective of this prospective observational study was to compare the postoperative sex steroid patterns in pediatric patients undergoing major cardiac surgery (MCS) versus those undergoing less intensive non-cardiac surgery. Urinary excretion rates of estrogen, progesterone, and androgen metabolites (μg/mmol creatinine/m(2) body surface area) were determined in 24-h urine samples before and after surgery using gas chromatography-mass spectrometry in 29 children undergoing scheduled MCS and in 17 control children undergoing conventional non-cardiac surgery. Eight of the MCS patients had Down's syndrome. There were no significant differences in age, weight, or sex between the groups. Seven patients from the MCS group showed multi-organ dysfunction after surgery. Before surgery, the median concentrations of 17-beta-estradiol, pregnanediol, 5-alpha-dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA) were (control/MCS) 0.1/0.1(NS), 12.4/11.3 (NS), 4.7/4.4 (NS), and 2.9/1.1 (p=0.02). Postoperatively, the median delta 17-beta-estradiol, delta pregnanediol, delta DHT, and delta DHEA were (control/MCS) 0.2/6.4 (p=0.0002), -3.2/23.4 (p=0.013), -0.6/3.7 (p=0.0004), and 0.5/4.2 (p=0.004). Postoperative changes did not differ according to sex. We conclude that MCS, but not less intensive non-cardiac surgery, induced a distinct postoperative increase in sex steroid levels. These findings suggest that sex steroids have a role in postoperative metabolism following MCS in prepubertal children.
    Steroids 11/2013; · 2.72 Impact Factor
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    ABSTRACT: Objective: To address the questions whether cardiac surgery with cardiopulmonary bypass (CPB) triggers a more intense adrenal stress response and an altered cortisol metabolism compared to surgery without CPB?
    Pediatric Research 11/2011; · 2.84 Impact Factor
  • I D Welters, C Neuhäuser
    BJA British Journal of Anaesthesia 11/2011; 107(5):813-4. · 4.24 Impact Factor
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    ABSTRACT: Background: Cardiac surgery with cardiopulmonary Bypass (CPB) leads to increased adrenal stress response. The role of androgens like testosterone or dihydrotestosterone (DHT) in mortality of critically ill adult patients is well known. In estrogens, antiinflammatory effects via inhibition of inflammatory cytokine transcription have been described and are associated with better neurological outcome. Data on postoperative metabolism of sex steroids after cardiac surgery on CPB are rare.
    Pediatric Research 11/2011; · 2.84 Impact Factor
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    ABSTRACT: The primarily anuric very low birth weight infant (VLBWI) is an ethical challenge for the attending doctor as well as for the parents. Long term peritoneal dialysis (PD) might provide an acceptable way in treating a primarily anuric VLBWI prior to kidney transplantation without endangering the child's neurologic development. We report a case of a VLBWI born at 30 weeks gestational age after anhydramnion for 5 weeks. Postnatally the neonate had persisting anuria and was successfully treated with peritonealdialysis for 31 months followed by hemodialysis for 12 months and eventually received a renal transplantion at the age of 43 months.
    Klinische Pädiatrie 09/2011; 224(2):76-9. · 1.90 Impact Factor
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    ABSTRACT: Coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB) leads to elevated circulating plasma cytokines. In this prospective randomized study, the effect of an S-(+)-ketamine-based anaesthetic protocol on perioperative plasma cytokine levels was compared with standard anaesthesia with propofol and sufentanil during CPB. Patients undergoing elective on-pump CABG were randomly allocated to anaesthesia with sufentanil-propofol-midazolam (Sufentanil) or S-(+)-ketamine-propofol-midazolam (Ketamine). Blood samples were obtained before induction of anaesthesia (baseline) and also at 1, 6, and 24 h after aortic unclamping. Plasma levels of the interleukins (IL)-6, IL-8, IL-10, and tumour necrosis factor (TNF)-alpha were determined by enzyme-linked immunosorbent assay. One hundred and twenty-eight patients were studied (Ketamine: n=60; Sufentanil: n=68). All measured cytokines increased during and after CPB. However, the increase in the pro-inflammatory cytokines IL-6 and IL-8 6 h after aortic unclamping was significantly lower in the Ketamine group compared with the Sufentanil group [mean (sd): IL-6 56.75 (46.28) pg ml⁻¹ (Ketamine) vs 172.64 (149.93) pg ml⁻¹ (Sufentanil), P<0.01; IL-8 7.74 (14.72) pg ml⁻¹ (Ketamine) vs 26.3 (47.12) pg ml⁻¹ (Sufentanil), P<0.01]. In contrast, the anti-inflammatory cytokine IL-10 showed higher levels 1 h after unclamping in the Ketamine group compared with the Sufentanil group [mean (sd): 69.59 (78.78) vs 24.63 (37.7) pg ml⁻¹, P<0.001]. Our data demonstrate that S-(+)-ketamine possesses anti-inflammatory potential. Anaesthesia with S-(+)-ketamine may have beneficial effects in attenuating the CPB-induced systemic inflammatory response.
    BJA British Journal of Anaesthesia 02/2011; 106(2):172-9. · 4.24 Impact Factor
  • C Neuhäuser, J Welter, C Arendt, L Bindl, B Schmitz
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    ABSTRACT: The case of a 13-month-old child who developed a life-threatening macroglossia with airway obstruction following palatoplasty for a cleft palate is reported. As direct laryngoscopy was not feasible a laryngeal mask (LM) was inserted to secure the airway. Under fiber optic guidance an endotracheal tube was then introduced via the LM. In this article the incidence, pathophysiology, clinical dynamics, options for emergency anesthesia management and organizational implications of this rare but typical complication in the field of oral and craniomaxillofacial surgery are reported.
    Der Anaesthesist 12/2010; 59(12):1102-4. · 0.74 Impact Factor
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    ABSTRACT: Es wird über ein 13Monate altes Kind berichtet, dass kurz nach Gaumenspaltenverschluss eine lebensbedrohliche Makroglossie mit Atemwegsobstruktion entwickelte. Da die direkte Laryngoskopie unmöglich war, wurde der Atemweg zunächst mithilfe der Larynxmaske gesichert und das Kind anschließend darüber fiberoptisch endotracheal intubiert. Dieser Beitrag beschreibt Inzidenz, Pathophysiologie, klinische Dynamik, Möglichkeiten des anästhesiologischen Notfallmanagements und organisatorische Implikationen dieser sehr seltenen, aber typischen Komplikation aus dem Bereich der Mund-, Kiefer- und Gesichtschirurgie. The case of a 13-month-old child who developed a life-threatening macroglossia with airway obstruction following palatoplasty for a cleft palate is reported. As direct laryngoscopy was not feasible a laryngeal mask (LM) was inserted to secure the airway. Under fiber optic guidance an endotracheal tube was then introduced via the LM. In this article the incidence, pathophysiology, clinical dynamics, options for emergency anesthesia management and organizational implications of this rare but typical complication in the field of oral and craniomaxillofacial surgery are reported. SchlüsselwörterGaumenspalte–Makroglossie–Atemwegsobstruktion–Larynxmasken–Fiberoptische Technik KeywordsCleft palate–Macroglossia–Airway obstruction–Laryngeal masks–Fiber optic technology
    Der Anaesthesist 12/2010; 59(12):1102-1104. · 0.74 Impact Factor
  • Klinische Pädiatrie 06/2010; 222. · 1.90 Impact Factor
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    ABSTRACT: Painful procedures on children and adolescents often have to be performed with the aid of analgesia and sedation in order to prevent pain and emotional distress. Moreover, many procedures can be performed more rapidly and more effectively in a relaxed patient. Because the combination of analgesia and sedation can cause serious or even life-threatening complications, it must be accompanied by the same safety precautions as a general anesthetic. Selective review of the literature. A high level of safety can be achieved by adherence to the published guidelines of the societies for anesthesiology and pediatrics. The depth of sedation during procedures performed under combined analgesia and sedation is often equivalent to that resulting from general anesthesia. Therefore, in order to avoid serious complications, combined analgesia and sedation should only be administered by physicians trained in pediatric anesthesia or pediatric critical care. This is particularly so when propofol is used, because it has a narrow therapeutic range and can cause cardiorespiratory respiratory problems without warning. As long as the appropriate safety precautions are followed, non-anesthesiologists can also administer propofol in combination with an analgesic, such as ketamine, to children and adolescents. In children and adolescents, the combination of analgesia and sedation can prevent the emotional trauma that would result from a painful procedure, while often enhancing the quality of the procedure itself. This method should be considered a variant of general anesthesia. Accordingly, any non-anesthesiologist employing this method must be as well versed as an anesthesiologist in the management of its specific side effects and complications.
    Deutsches Ärzteblatt International 04/2010; 107(14):241-7, I-II, I. · 3.61 Impact Factor
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    ABSTRACT: Recent data indicate that ketamine exerts antiinflammatory actions. However, little is known about the signaling mechanisms involved in ketamine-induced immune modulation. In this study, we investigated the effects of ketamine on lipopolysaccharide-induced activation of transcription factors activator protein 1 (AP-1) and nuclear factor-kappaB (NF-kappaB) in human leukocyte-like cell lines and in human blood neutrophils. Electric mobility shift assays were used to investigate ketamine's effects on nuclear binding activity of both transcription factors in U937 cells, and a whole blood flow cytometric technique was used for AP-1 and NF-kappaB determination in leukocytes. Cell lines with different expression patterns of opioid and N-methyl-D-aspartate receptors were used for reverse transcription-polymerase chain reaction to investigate receptors involved in ketamine signaling. Ketamine's effect on interleukin-8 production was assessed in a whole blood assay. Ketamine inhibited both transcription factors in a concentration-dependent manner. These effects did not depend on opiate or N-methyl-D-aspartate receptors. Ketamine also reduced interleukin-8 production in whole blood and expression of CD11b and CD16 on neutrophils. The immunoinhibitory effects of ketamine are at least in part caused by inhibition of transcription factors NF-kappaB and AP-1, which regulate production of proinflammatory mediators. However, signaling mechanisms different from those present in the central nervous system are responsible for ketamine-mediated immunomodulation.
    Anesthesia and analgesia 03/2010; 110(3):934-41. · 3.42 Impact Factor
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    ABSTRACT: After surgical repair of congenital heart disease, inotropic support is sometimes necessary to wean from cardiopulmonary bypass. In pediatric cardiac surgery, dobutamine and dopamine are often used as inotropic support. Dopexamine is a synthetic catecholamine, which has positive inotropic and vasodilating properties. Because the hemodynamic effects of catecholamines are modified after cardiopulmonary bypass, the aim of this study was to investigate the effects of dobutamine and dopexamine on cardiac index and systemic vascular resistance index after cardiopulmonary bypass in pediatric cardiac surgery. The study was performed in a prospective, randomized, and double-blinded cross-over design. The investigation included 11 children for elective, noncomplex congenital heart surgery. After weaning from cardiopulmonary bypass and a 20-min period of steady state, children received either 2.5 microg x kg(-1) x min(-1) dobutamine or 1 microg x kg(-1) x min(-1) dopexamine for 20 min. Cardiac index (transpulmonary thermodilution), mean arterial pressure, central venous pressure, stroke volume, systemic vascular resistance, and central venous oxygen saturation were determined. The primary outcome variable was cardiac index. No difference in cardiac index was observed between the two groups (P = 0.594). Both drugs increased cardiac index, dopexamine from 3.9 +/- 0.6 to 4.7 +/- 0.8 l x min(-1) x m(-2) (P = 0.003) and dobutamine from 4.1 +/- 0.7 to 4.8 +/- 0.7 l x min(-1) x m(-2) (P = 0.004). During treatment with dobutamine, children presented with significantly higher mean arterial pressure (P = 0.003) and systemic vascular resistance index (P = 0.026). This trial demonstrates that low-dose dobutamine and dopexamine both increase cardiac index during pediatric cardiac surgery but with different hemodynamic effects.
    Pediatric Anesthesia 08/2009; 19(9):862-71. · 2.44 Impact Factor
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    ABSTRACT: S-(+)-ketamine anaesthesia carries potential benefits for the cardiovascularly compromised patient. However, the use of S-(+)-ketamine in ischaemic coronary artery disease is controversial. In a prospective, randomized, clinical trial, we have investigated whether an S-(+)-ketamine-based anaesthetic protocol leads to increased cardiac troponin T levels (cTnT) after coronary artery bypass grafting (CABG). Two hundred and nine patients undergoing elective CABG were randomized to receive either i.v. anaesthesia with sufentanil-midazolam-propofol (SMP; n=108) or S-(+)-ketamine-midazolam-propofol (KMP; n=101). Haemodynamic variables were maintained within the normal range. Invasive haemodynamic monitoring was performed using a pulmonary artery catheter. Plasma cTnT levels were sampled before induction and 1, 6, and 24 h after aortic unclamping. Cardiovascular adverse events, such as electrocardiographic signs of ischaemia, perioperative myocardial infarction, and death, were recorded. Patient characteristics, cardiac profile, intraoperative management, and the incidence of cardiovascular adverse events were comparable between the groups. Plasma cTnT levels increased after operation in both groups. cTnT levels were significantly lower in the KMP group 6 h after aortic unclamping compared with the SMP group (P=0.004), but did not differ 24 h after aortic unclamping [median (range): SMP 0.4 (0.01-3.9) vs KMP 0.4 (0.07-6.6) microg litre(-1), P=0.338]. S-(+)-ketamine does not accentuate postoperative cTNT rises in haemodynamically stable elective CABG patients.
    BJA British Journal of Anaesthesia 07/2008; 100(6):765-71. · 4.24 Impact Factor
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    ABSTRACT: Background:  Infiltrative anesthesia of the scalp with lidocaine was used in an attempt to reduce blood loss and anesthetic requirements during pediatric craniofacial surgery. Lidocaine, however, has the potential to cause methemoglobinemia. In this retrospective cohort-study we analyzed the incidence and effects of postoperative methemoglobinemia following subcutaneous lidocaine administration.Methods:  During 1999–2006, 50 infants (age: 3–31 months) undergoing elective craniofacial surgery were analyzed. All infants received general anesthesia and routine monitoring, including invasive arterial blood pressure measurement. Prior to incision, the scalp was infiltrated with 6–15 ml lidocaine 1% (with epinephrine 1 : 200.000). Blood loss and blood transfusions were recorded. Methemoglobin (Met-Hb) levels were determined postoperatively using co-oximetry.Results:  Twenty percent of the operated infants showed elevated Met-Hb levels (median of maximal levels: 6%; range: 2.2–18%) at admission on the PICU. In 80% of these methemoglobinemia resolved spontaneously within 12 h, only two children received methylene blue because of visible cyanosis. The intra- and postoperative course was otherwise uneventful in all the children despite significant total blood loss (median of blood loss as percentage from total estimated blood volume: 43%; range: 11–110%). Lidocaine was the only substance identified to have the potential to cause methemoglobinemia. However, the average administered dose of lidocaine was not significantly different between patients with or without methemoglobinemia (13 ± 3.1 vs 12 ± 3.5 mg·kg−1; P = 0.37).Conclusions:  Even though we did not measure lidocaine plasma levels, lidocaine was the most likely cause of postoperative methemoglobinemia. Despite a high incidence, methemoglobinemia occurred sporadically and was without dangerous consequences.
    Pediatric Anesthesia 01/2008; 18(2):125 - 131. · 2.44 Impact Factor
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    ABSTRACT: Patients who require extracorporeal membrane oxygenation (ECMO) postsurgery for congenital heart disease (CHD) frequently experience severe bleeding episodes. Whereas recombinant-activated factor VII (rFVIIa) has proven efficacy in counteracting intractable hemorrhage in various scenarios, its use in patients on ECMO is limited by the increased risk for thrombotic events. Between December 2004 and January 2006, ECMO was used in 10 pediatric patients following cardiac surgery, of whom seven were treated with rFVIIa because of intractable hemorrhage. Their medical records were reviewed with respect to variations in chest tube output and transfusion requirements, occlusion of or thrombus formation in the ECMO circuit and the occurrence of thromboembolic events. Outcome and rate of ECMO circuit occlusion were compared with historic controls. Three patients died, and four survived (none of the deaths was attributable to thrombus formation or bleeding). All patients were treated with aprotinin prior to and during rFVIIa therapy. Two patients developed an occlusion of the oxygenator, one after receiving co-medication with a FXIII concentrate, another after RBC transfusion in the ECMO system. In two patients, thrombus formation was observed in the ECMO system on inspection after discontinuation. Thromboembolic events were not observed. Recombinant-activated factor VII in a median dosage of 90 microg.kg(-1) was used in seven pediatric patients on ECMO. Rates of ECMO system occlusions and mortality did not differ from historic controls. Neither the reduction of chest tube output nor the blood product transfusion requirements did reach statistical significance.
    Pediatric Anesthesia 01/2008; 17(12):1176-81. · 1.74 Impact Factor
  • D Klauwer, D Faas, C Waskow, C Neuhäuser, M Heckmann
    Zeitschrift für Geburtshilfe und Neonatologie 01/2007; 211. · 0.46 Impact Factor
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    Critical Care 01/2007; 11. · 5.04 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate whether isoflurane, a known negative lusitropic agent, exacerbates diastolic dysfunction in patients with preexisting impaired relaxation. Prospective, experimental study. Single-institution, university hospital. Twenty-five patients with diastolic dysfunction due to concentric hypertrophy and ischemic heart disease undergoing elective coronary artery bypass graft surgery. After approval of the local ethics committee and informed consent, patients randomly received sufentanil/midazolam anesthesia plus either 0.5 to 1.0 minimum alveolar concentration of isoflurane (n = 15) or weight-adjusted boli of urapidil (n = 10) during preparation of the internal mammary artery. Changes in hemodynamic parameters and echocardiographic diastolic indices before and after drug administration were compared. Filling pressures during the study were kept constant within normal range. Hemodynamic changes measured by invasive arterial and pulmonary arterial pressures were comparable between isoflurane and urapidil. Both interventions led to a marked reduction in afterload that was accompanied by a significant increase in thermodilution cardiac output and stroke volume. Transesophageal echocardiographic relaxation indices were also comparable between groups. Transmitral and tissue Doppler E waves increased significantly, leading to larger E/A and Em/Am ratios; whereas the deceleration time and the isovolumetric relaxation time decreased significantly. Isoflurane did not exacerbate diastolic dysfunction in patients with concentric hypertrophy and ischemic heart disease. In contrast, isoflurane led to a "normalization" of the relaxation pattern that was attributed to a reduction in left-ventricular loading conditions.
    Journal of Cardiothoracic and Vascular Anesthesia 09/2006; 20(4):509-14. · 1.48 Impact Factor
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    ABSTRACT: We evaluated microfocal X-ray-computed tomography (micro-CT) as a method to visualize lung architecture two and three dimensionally and to obtain morphometric data. Inflated porcine lungs were fixed by formaldehyde ventilation. Tissue samples (8-mm diameter, 10-mm height) were stained with osmium tetroxide, and 400 projection images (1,024 x 1,024 pixel) were obtained. Continuous isometric micro-CT scans (voxel size 9 microm) were acquired to reconstruct two- and three-dimensional images. Tissue samples were sectioned (8-microm thickness) for histological analysis. Alveolar surface density and mean linear intercept were assessed by stereology-based morphometry in micro-CT scans and corresponding histological sections. Furthermore, stereology-based morphometry was compared with morphometric semi-automated micro-CT analysis within the same micro-CT scan. Agreement of methods was assessed by regression and Bland-Altman analysis. Comparing histology with micro-CT, alveolar surface densities (35.4 +/- 2.4 vs. 33.4 +/- 1.9/mm, P < 0.05) showed a correlation (r = 0.72; P = 0.018) with an agreement of 2 +/- 1.6/mm; the mean linear intercept (135.7 +/- 14.5 vs. 135.8 +/- 15 microm) correlated well (r = 0.97; P < 0.0001) with an agreement of -0.1 +/- 3.4 microm. Semi-automated micro-CT analysis resulted in smaller alveolar surface densities (33.4 +/- 1.9 vs. 30.5 +/- 1/mm; P < 0.01) with a correlation (r = 0.70; P = 0.023) and agreement of 2.9 +/- 1.4/mm. Non-destructive micro-CT scanning offers the advantage to visualize the spatial tissue architecture of small lung samples two and three dimensionally.
    AJP Lung Cellular and Molecular Physiology 09/2006; 291(3):L535-45. · 4.04 Impact Factor

Publication Stats

156 Citations
62.95 Total Impact Points

Institutions

  • 2006–2014
    • Justus-Liebig-Universität Gießen
      • Department of Anaesthesiology and Intensive Care Medicine
      Gieben, Hesse, Germany
  • 2002–2011
    • Universitätsklinikum Gießen und Marburg
      • Abteilung für Anästhesie
      Marburg, Hesse, Germany
  • 2010
    • Centre Hospitalier de Luxembourg
      Letzeburg, Luxembourg, Luxembourg