Gabriele Nöldge-Schomburg

University of Rostock, Rostock, Mecklenburg-Vorpommern, Germany

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Publications (86)178.6 Total impact

  • M. Sauer · J. Altrichter · S. Doß · F. Doß · T. Wild · G. Richter · J. Ehler · T. Mencke · G. Nöldge-Schomburg · S. Mitzner ·
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    ABSTRACT: Objectives Granulocyte transfusions (GTx) have been used to treat immune cell dysfunction in sepsis. As GTx can trigger tissue injury via local effects of neutrophils we hypothesized that extracorporeal treatment of plasma using granulocytes would prove beneficial while having less side effects. In a first in man study an extracorporeal granulocyte treatment appeared to be safe and showed promising efficacy, we would study the effects of this treatment on the hemodynamic system and the liver function [1]. Methods Nine consecutive patients with septic shock and one patient with severe sepsis were included in a prospective uncontrolled clinical study with 28 day and hospital survival follow up on two university hospital intensive care units. All patients were treated twice within 72h with an extracorporeal bioreactor containing 12.3 (10.4-14.4) x10E10 granulocytes from healthy donors. On average 11.7 (10.3-12.0) liters separated plasma were treated by the therapeutic donor cells. Survival, physiologic, biochemical, hematologic parameters, hemodynamic changes using dynamic hemodynamic monitoring with the PiCCO-System and the indocyanine green plasma disappearance rate (PDR) were monitored for 28 days. Plasma of patients before and after extracorporeal treatments were tested with a cell based biosensor (HepG2/C3A) for analysis of hepatotoxicity [2]. In a standardised mikrotiterplate assay the toxicity of patient plasma was tested. After incubation with plasma from patients the viability of cells (XTT test, Trypanblue-staining), the cytochrome 1A2 activity (metabolism of etoxyresorufin) and synthesis of albumin was measured. Results The observed mortality rate was 40% within 28 days, and 50% during stay in hospital. At inclusion or on day 1 the dosage of norepinephrine, the values of bilirubin and the median SAPS-II were significantly higher in non-survivors than in survivors. During the treatments, the norepinephrine dosage could be significantly reduced while mean arterial pressure was stable and the cardiac index and the stroke volume index increased. In the cell-based analysis of hepatotoxicity (biosensor) the vitality, the synthesis of micro albumin and the activities of cytochrome 1A2 and mitochondrial dehydrogenases (XTT-test) increased significantly during extracorporeal treatment. Significant lower values of PDR were found in non-survivors than in-survivors on day 1 before extracorporeal treatment and an increase of PDR from day 1 to day 7 in survived patients. In contrast to this, during the extracorporeal treatments no significant changes of PDR-values could be observed. Conclusions The extracorporeal treatment with donor granulocytes appeared to be safe and showed promising effects on the hemodynamic system of patients and on the liver cell function and viability in a cell-based biosensor.
    World Conference on Regenerative Medicine 2015, Congress Center Leipzig, Germany; 10/2015
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    ABSTRACT: Cardiogenic shock following acute myocardial infarction is associated with high mortality rate. Different management concepts including fluid management, inotropic support, intra aortic balloon counterpulsation (IABP) and extracorporeal membrane oxygenation (ECMO) mainly in mechanically ventilated patients have been used as cornerstones of management. However, success rates have been disappointing. Few reports suggested that ECMO when performed under circumvention of mechanical ventilation, may offer some survival benefits.
    Heart, Lung and Circulation 10/2014; 23(10). DOI:10.1016/j.hlc.2014.06.008 · 1.44 Impact Factor
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    ABSTRACT: BackgroundTracheal intubation without muscle relaxants is usually performed with remifentanil and propofol or sevoflurane. Remifentanil 1.0 to 4.0 μg·kg-1 and propofol 2.0-3.0 mg·kg-1 or sevoflurane up to 8.0 Vol% provide acceptable, i.e. excellent or good intubating conditions. We hypothesized that sevoflurane 1.0 MAC would provide acceptable intubating conditions when combined with propofol and remifentanil.MethodsEighty-three patients to be intubated were randomised to two groups. The SEVO group received propofol 1.5 mg kg-1, remifentanil 0.30 μg kg min-1 and sevoflurane 1.0 MAC; the MR group received the same doses of propofol and remifentanil plus rocuronium 0.45 mg kg-1. We evaluated intubation and extubation conditions, mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS). The vocal cords were examined for injury by videolaryngoscopy before and 24 hours after surgery.ResultsAcceptable intubating conditions were seen more frequently with rocuronium than with sevoflurane: 97% versus 82%; p = 0.03; the subscore for vocal cords was comparable: 100% versus 98%. MAP before intubation decreased significantly compared with the MAP at baseline to the same extent in both groups; ephedrine IV was given in 15 (SEVO) versus 16 (MR) patients; p = 0.93. BIS at tracheal intubation was 27 (13-65) in the SEVO group, 29 (14-62) in the MR group; p = 0.07. Vocal cord injuries (oedema, haematoma) were similar: 4 patients in each group.ConclusionsOverall intubating conditions were better when rocuronium was used; the subscore for vocal cords was comparable. The incidence of side effects was the same in the two groups.Trial registrationClinicalTrials.Gov: NCT 01591031.
    BMC Anesthesiology 05/2014; 14:39. DOI:10.1186/1471-2253-14-39 · 1.38 Impact Factor
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    ABSTRACT: The hallmarks of acute lung injury (ALI) are the compromised alveolar-capillary barrier and the extravasation of leukocytes into the alveolar space. Given the fact that the peroxisome proliferator-activated receptor-γ agonist rosiglitazone holds significant anti-inflammatory properties, we aimed to evaluate whether rosiglitazone could dampen these hallmarks of local pulmonary inflammation in a porcine model of lung injury. For this purpose, we used a model of lipopolysaccharide (LPS, 50 μg/kg)-induced ALI. One hundred twenty minutes following the infusion of LPS, we started the exposure to rosiglitazone through inhalation or infusion. We found that intravenous rosiglitazone significantly controlled local pulmonary inflammation as determined through the expression of cytokines within the alveolar compartment. Furthermore, we found a significant reduction of the protein concentration and neutrophil activity within the alveolar space. In summary, we therefore conclude that the treatment with rosiglitazone might dampen local pulmonary inflammation during the initial stages of ALI.
    Inflammation 02/2014; 37(4). DOI:10.1007/s10753-014-9834-0 · 2.21 Impact Factor
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    ABSTRACT: Toll-like receptor 2 (TLR2)-deficiency is associated with the preservation of vascular function and TLR2-deficient (TLR2(-/-)) mice exhibit increased neovascularization following induction of hindlimb ischemia. Hematopoietic stem cells play an important role in ischemia-induced angiogenesis and we now investigated whether the effects observed in TLR2(-/-) mice may be attributed to TLR2 deficiency on bone marrow-derived stem cells. Approach and Results: cKit-positive (cKit(+)) bone marrow cells (BMC) were isolated from wild type (WT) and TLR2(-/-) mice employing MACS-bead technology. Co-incubation of TLR2(-/-)cKit(+) BMC with mature endothelial cells (ECs) resulted in increased tube formation of ECs on matrigel, augmented sprouting in a 3D-collagen matrix and increased migratory capacity compared to co-incubation with WT cKit(+) BMC. In an in vivo matrigel plug assay, TLR2(-/-)cKit(+) BMC exhibited enhanced formation of capillary-like networks. In a murine model of hindlimb ischemia, administration of TLR2(-/-) cKit(+) BMC to WT mice augmented capillary density and reperfusion of ischemic M. gastrocnemius muscle tissue to the level of TLR2(-/-) mice. Western Blot analysis revealed comparable expression of CXCR4 on TLR2(-/-)cKit(+) BMC but increased activation of the PI3K downstream signaling molecule protein kinase B (PKB/AKT) compared to WT cKit(+) cells. The absence of TLR2 on cKit(+) BMC is associated with augmented potency to support angiogenic processes in vitro and in vivo. Functional inhibition of TLR2 may therefore provide a novel tool to enhance stem cell function for the treatment of vascular diseases.
    International journal of clinical and experimental pathology 12/2013; 6(12):2813-23. · 1.89 Impact Factor
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    ABSTRACT: Cardiac arrest (CA) followed by cardiopulmonary resuscitation (CPR) is associated with poor survival rate and neurofunctional outcome. Toll-like receptor 2 (TLR2) plays an important role in conditions of sterile inflammation such as reperfusion injury. Recent data demonstrated beneficial effects of the administration of TLR2-blocking antibodies in ischemia/reperfusion injury. In this study we investigated the role of TLR2 for survival and neurofunctional outcome after CA/CPR in mice. Female TLR2-deficient (TLR2(-/-)) and wild type (WT) mice were subjected to CA for eight min induced by intravenous injection of potassium chloride and CPR by external chest compression. Upon the beginning of CPR, n = 15 WT mice received 5 µg/g T2.5 TLR2 inhibiting antibody intravenously while n = 30 TLR2(-/-) and n = 31 WT controls were subjected to injection of normal saline. Survival and neurological outcome were evaluated during a 28-day follow up period. Basic neurological function, balance, coordination and overall motor function as well as spatial learning and memory were investigated, respectively. In a separate set of experiments, six mice per group were analysed for cytokine and corticosterone serum levels eight hours after CA/CPR. TLR2 deficiency and treatment with a TLR2 blocking antibody were associated with increased survival (77% and 80% vs. 51% of WT control; both P < 0.05). Neurofunctional performance was less compromised in TLR2(-/-) and antibody treated mice. Compared to WT and antibody treated mice, TLR2(-/-) mice exhibited reduced IL-6 (both P < 0.05) but not IL-1β levels and increased corticosterone plasma concentrations (both P < 0.05). Deficiency or functional blockade of TLR2 is associated with increased survival and improved neurofunctional outcome in a mouse model of CA/CPR. Thus, TLR2 inhibition could provide a novel therapeutic approach for reducing mortality and morbidity after cardiac arrest and cardiopulmonary resuscitation.
    PLoS ONE 09/2013; 8(9):e74944. DOI:10.1371/journal.pone.0074944 · 3.23 Impact Factor
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    ABSTRACT: Endotracheal intubation has been associated with a threefold higher incidence of laryngopharyngeal complaints following anesthesia in comparison to laryngeal mask airway. Such complaints, including hoarseness and sore throat, have been reported in up to 90 % of patients within 24 h of extubation. The purpose of this study was to determine which preoperatively documented clinical and anatomic parameters are predictive of laryngo-pharyngeal trauma resulting from elective endotracheal intubation. Fifty-three patients undergoing ENT procedures requiring general anesthesia with endotracheal intubation were recruited. Pre and postoperative laryngostroboscopic examination was performed and findings correlated to preoperative clinical and anatomic parameters. Readily assessed anatomic parameters including height (>180 cm) and weight (>80 kg) correlated significantly to the Eckerbom grade of intubation-associated acute laryngeal injury (rs = 0.374; p = 0.006 and rs = 0.278; p = 0.044, respectively). The mandibular protrusion test also correlated significantly to the Eckerbom grade (rs = 0.462, p = 0.001) while the upper-lip-bite test showed significant correlation to impaired vocal fold oscillation (rs = 0.288, p = 0.036), with injury prediction sensitivities of 37.5 and 39.4 %, respectively. No parameters correlated to subjective complaints (n = 5, 9.2 %). This study provides suggestions on how to improve the classification of intubation-associated laryngeal injuries as well as providing the basis for larger clinical trials in other surgical subspecialties.
    Archives of Oto-Rhino-Laryngology 08/2013; 271(2). DOI:10.1007/s00405-013-2659-x · 1.55 Impact Factor
  • G Rücker · J Ahrens · G Nöldge-Schomburg · T Mencke ·

    Der Notarzt 08/2013; 29(04). DOI:10.1055/s-0033-1350091 · 0.29 Impact Factor
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    ABSTRACT: The routine use of neuromuscular blocking drugs (NMBD) for endotracheal intubation in children is the subject of much controversy. The analysis of heart rate variability (HRV) can reveal information about the functional state of the autonomic nervous system (ANS). The purpose of this study was to determine if HRV elucidates differences in the sympathovagal balance of children undergoing elective endo-tracheal intubation with and without neuromuscular blockade (NMB). In this prospective study, 38 children (2-6 years) scheduled for adenotonsillectomy were randomized into two groups to receive fentanyl 2 μg·kg(-1) and propofol 4 mg·kg(-1) , with either mivacurium 0.25 mg·kg(-1) (NMB group) or saline solution (NoNMB group) for anesthesia induction. The same experienced, blinded anesthesiologist performed endotracheal intubation. Heart rate variability, RR intervals, ECG as well as an electroencephalogram were recorded with HRV and BIS XP monitors, respectively. Heart rate variability was analyzed in the frequency domain. There was no significant difference in HRV changes immediately after mivacurium administration compared with an administration of saline. The groups were comparable for the bispectral index value (NMB 35 [33-41] vs NoNMB 34 [32-42]) during endotracheal intubation. Changes in both the low-frequency power and the low-/high-frequency ratio immediately after endotracheal intubation compared with the unstimulated state before laryngoscopy were significantly higher without NMB (P = 0.015 and P = 0.006, respectively), whereas there was no significant difference with respect to the high-frequency power. The stress response during endotracheal intubation in pediatric patients represented by the frequency domain analysis of HRV was found to be higher without NMB. When mivacurium was added to a propofol-fent-anyl induction regimen, the ANS alterations during endotracheal intubation decreased significantly.
    Pediatric Anesthesia 08/2013; 23(12). DOI:10.1111/pan.12236 · 1.85 Impact Factor
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    Nana-Maria Wagner · Laura Bierhansl · Gabriele Nöldge-Schomburg · Brigitte Vollmar · Jan Patrick Roesner ·
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    ABSTRACT: Objective: Toll-like receptor 2 (TLR2) inhibition by function blocking antibodies (ABs) is associated with enhanced preservation of endothelial cell function during vascular disease. In the present study, we investigated the capacity of TLR2-blocking ABs to modulate the angiogenic response of endothelial cells in vitro and in vivo. Approach and results: Incubation of endothelial cells with mono- or polyclonal anti-TLR2 ABs resulted in increased tube formation, sprouting, and migration of endothelial cells compared with controls. In a mouse model of hindlimb ischemia, using TLR2-deficient or anti-TLR2 AB-treated wild-type mice resulted in increased new capillary formation and enhanced reperfusion. The effects of anti-TLR2 ABs were similar to those exerted by stromal cell-derived factor-1, and we show that anti-TLR2 ABs yet not TLR2 ligands lead to comparable activation of extracellular signal-regulated kinase1/2 and AKT but not p38 mitogen-activated protein kinase as activation of the CXCR4 canonical signal transduction pathways by stromal cell-derived factor-1. Immunoprecipitation of TLR2 revealed that anti-TLR2 ABs initiate an association of TLR2 with CXCR4 and mitogen-activated protein kinase activation. The proangiogenic properties of anti-TLR2 ABs were abolished by both G-protein inhibition and CXCR4 knockdown in endothelial cells. Conclusions: Our results provide evidence for a proangiogenic effect of TLR2-blocking ABs on endothelial cells in vitro and in vivo. They identify a novel molecular mechanism linking TLR2 to angiogenic processes that is independent from the activation of inflammatory cascades and further support the concept of a beneficial effect of TLR2 inhibition for endothelial cell function in vascular disease.
    Arteriosclerosis Thrombosis and Vascular Biology 05/2013; 33(8). DOI:10.1161/ATVBAHA.113.301783 · 6.00 Impact Factor
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    ABSTRACT: Anesthesia can be maintained with propofol or sevoflurane. Volatile anesthetics increase neuromuscular block of muscle relaxants. We tested the hypothesis, that sevoflurane would cause less vocal cord injuries than an intravenous anesthesia with propofol. In this prospective trial, 65 patients were randomized in 2 groups: SEVO group, anesthesia with sevoflurane, and TIVA group, total intravenous anesthesia with propofol. Intubating and extubating conditions were evaluated. Vocal cord injuries were examined by stroboscopy before and 24 and 72 h after surgery; hoarseness and sore throat were assessed up to 72 h after surgery. Hoarseness and sore throat were comparable between both groups (not significant). Similar findings were observed for vocal cord injuries: 9 (SEVO) versus 5 (TIVA) patients; P = 0.36; the overall incidence was 24%. Type of vocal cord injuries: 9 erythema and 5 edema of the vocal folds. Neuromuscular block was significantly longer in the SEVO group compared with the TIVA group: 71 (range: 38-148) min versus 52 (range: 21-74) min; P < 0.001. Five patients (TIVA group) versus 11 patients (SEVO group) needed neostigmine to achieve a TOF ratio of 1.0 (P = 0.14). Under anesthesia with propofol laryngeal injuries were not increased; the risk for residual curarization, however, was lower compared with sevoflurane.
    Anesthesiology Research and Practice 02/2013; 2013:723168. DOI:10.1155/2013/723168
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    ABSTRACT: In an extracorporeal combination therapy, the impact of different replacement fluids on survival was tested in a bacterial sepsis model in pigs. In an animal study 19 pigs, weighing 7.5-11.1 kg, were included. All groups received an intravenous lethal dose of live Staphylococcus aureus over 1 h. The animals were treated by an extracorporeal circuit consisting of online centrifugation and subsequent plasma filtration for 4 h. The extracorporeal circuit was pre-filled with 400 mL replacement fluid. In the P0 group 100% hydroxyethyl starch 130/0.4 was used as replacement fluid; in the P30 group 30% pig plasma and 70% hydroxyethyl starch; and in the P100 group 100% pig plasma. The observation time was 7 days. All animals of the group P100 survived, while all animals of group P0 and five out of seven animals of the P30 group died during the observation time. Extracorporeal therapy consisting of online centrifugation and plasma filtration with 100% pig plasma as replacement fluid significantly improved survival in a pig model of sepsis. Further studies with this approach are encouraged.
    Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 02/2013; 17(1):84-92. DOI:10.1111/j.1744-9987.2012.01103.x · 1.71 Impact Factor
  • Matthias Janda · Agnes Schubert · Jörn Bajorat · Rainer Hofmockel · Gabriele F.E. Nöldge-Schomburg · Bernhard P Lampe · Olaf Simanski ·
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    ABSTRACT: Introduction: Measuring and ensuring an adequate level of analgesia in patients are of increasing interest in the area of automated drug delivery during general anesthesia. Therefore, the aim of this investigation was to develop a control system that may reflect the intraoperative analgesia value. Our hypothesis was that a feedback controller could be applied in clinical practice safely and at an adequate quality of analgesia. The purpose of this study was to evaluate the practical feasibility of such a system in a clinical setting. Methods: The control system for the level of analgesia described in this paper relies on a parameter combination of heart rate variability (HRV), heart rate (HR), and blood pressure (mean arterial pressure, MAP), which serve as input variables for an expert system. For this fuzzy system, the experience of the participating anesthesiologists was translated into a set of fuzzy rules. In a pilot trial, the control system for automated titration of remifentanil, a short-acting opioid, was tested combined with a closed-loop propofol infusion system for hypnosis. Ten adult patients (4 women, 6 men), aged 22-52 years (median, 45 years; range, 29-49 years), with an American Society of Anesthesiologists physical status class I or II and who were scheduled for elective trauma surgery in a supine position were enrolled in this prospective trial. The precision of the system was calculated using internationally defined performance parameters. Results: There was no human intervention necessary during the computer-controlled administration of propofol and remifentanil, and operating conditions were satisfactory in all patients. All patients assessed the quality of anesthesia as "good" to "very good". Median performance error, median absolute performance error, and wobble for HR and MAP during maintenance of anesthesia were -8.98 (5.32), 10.08 (4.17), and 2.68 (1.29) and -4.51 (12.73), 13.63 (2.27), and 3.90 (2.08) [mean (SD)], respectively. Conclusion: The control system, reflecting the level of analgesia during general anesthesia designed and evaluated in this study, allows for a clinically practical, nearly fully automated infusion of an opioid during medium-length surgical procedures with acceptable technical requirements and an adequate precision.
    Biomedizinische Technik/Biomedical Engineering 12/2012; 58(1):1-11. DOI:10.1515/bmt-2012-0090 · 1.46 Impact Factor
  • G. Rücker · F. Hüttemann · G. Nöldge-Schomburg · T. Mencke ·
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    ABSTRACT: Hintergrund Neugeborene, Frühgeborene und Säuglinge werden in Deutschland häufig mit speziellen Fahrzeugen, sog. Babynotarztwagen (B-NAW) sowie in konventionellen Rettungswagen (RTW) in Inkubatoren transportiert. Bisher ist es gängige Praxis, die Säuglinge nicht fixiert auf einer Unterlage zu transportieren. Methoden Wir untersuchten bei verschiedenen Fahrzeugausstattungen bei Vollbremsungen aus 50 km/h heraus die Kraftbelastung, die auf einen eigens zu diesem Zweck von uns entwickelten Säuglingsdummy einwirkte. Ergebnisse Dabei traten Kräfte bis zu 10 G auf. Auch bei niedrigerer Bremsgeschwindigkeit traten erhebliche Kräfte auf. Schlussfolgerung Es ist zwingend notwendig, solche Patienten mit Rückhaltesystemen zu schützen, um Schäden im Falle einer Vollbremsung oder einer Kollision zu vermeiden.
    Notfall 12/2012; 15(8):690-693. DOI:10.1007/s10049-012-1649-7 · 0.47 Impact Factor
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    ABSTRACT: The impact on survival of a combination of plasma separation by centrifugation and subsequent plasma filtration was tested in a bacterial sepsis model in pigs. In this animal study 19 pigs were included. Groups II and III received an intravenous lethal dose of live Staphylococcus aureus over 1 h; group I received saline (non-septic control--NC). Groups I and II were treated by an extracorporeal circuit consisting of online centrifugation and subsequent plasma filtration (group II: treated group--TG) for 4 h; group III had no specific treatment (septic control, SC). The observation time was 7 days. All animals of group I (NC) and group II (TG) survived, while all animals of group III (SC) died during the observation time. Extracorporeal therapy with online centrifugation and plasma filtration significantly improved survival in a pig model of sepsis. Further studies with this approach are encouraged.
    Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 06/2012; 16(3):205-12. DOI:10.1111/j.1744-9987.2011.01055.x · 1.71 Impact Factor
  • M Janda · J Bajorat · O Simanski · G Nöldge-Schomburg · R Hofmockel · M Schütze ·
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    ABSTRACT: The life-threatening effects of intracranial hypertension on brain perfusion and cerebral metabolism are the subject of current research in different animal models. The purpose of this study was to describe an efficient, reliable and inexpensive surgical method for temporary elevation of intracranial pressure (ICP) in acutely instrumented pigs in a research setting. Therefore, a balloon catheter was inserted into the left lateral ventricle and an ICP sensor was placed in the parenchyma of the right cerebral hemisphere. Ten acutely instrumented pigs were studied while under deep terminal general anaesthesia. The step-by-step inflation of the intraventricular balloon allows one to achieve the desired ICP up to 46 mmHg and maintain it at this level. ICP values ranged from a median of 2 (1-2) mmHg to 43 (29-45) mmHg. To the authors' knowledge, this is the first detailed description of a minimally invasive surgical technique for temporary ICP elevation in pigs via stepwise inflation of an intraventricular balloon.
    Laboratory Animals 04/2012; 46(3):258-60. DOI:10.1258/la.2011.011149 · 1.12 Impact Factor
  • Martin Sauer · Cristof Haubner · Thomas Mencke · Gabriele Nöldge-Schomburg · Steffen Mitzner · Jens Altrichter · Jan Stange ·
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    ABSTRACT: The development of liver failure is a major problem in septic patients. In this prospective clinical experimental study the hepatotoxicity of plasma from septic and non-septic patients was tested. The basic test components consist of human liver cells (HepG2/C3A) used in a standardized microtiter plate assay. After incubation with patient's plasma viability of cells (XTT-test), the cytochrome 1A2 activity and synthesis of micro albumin were measured. Subjects (28) enrolled comprise the septic shock group (SSG, n=10), the non-septic group (NSG, n=5) and the healthy volunteers group (HVG, n=13). The 28-day mortality was 30% in the SSG. The APACHE II-, SOFA-, and SAPS-scores and the values of bilirubin and prothrombin time as INR were significantly higher in the SSG than in the NSG. The cytochrome 1A2 activity and the release of albumin were significantly reduced in HepG2/C3A cells incubated with plasma of the SSG (p<0.05). The cytochrome 1A2 activities were higher in survivors compared to non-survivors at the time point 0 and were increasing in survivors and decreasing in non-survivors within 54 h in the SSG. In the SSG there was a significant decrease in IL-10 and IL-8 between inclusion and 54 h. Values of IL-6, TNF alpha and IL-10 were significantly lower in the NSG compared with the values of the SSG at inclusion and after 54 h. The plasma of patients with septic shock impaired cellular functions of HepG2/C3A cells.
    Agents and Actions 02/2012; 61(6):609-16. DOI:10.1007/s00011-012-0451-9 · 2.35 Impact Factor
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    ABSTRACT: To evaluate the short-term outcome of patients predominantly at high risk treated with the MitraClip® device for severe mitral valve regurgitation (MR) using one or more clips. We prospectively analyzed patients with highly symptomatic MR classified as inoperable (logistic EuroSCORE 24.16 ± 13.64%; STS-score 29.9 ± 14.5%) but subject to mitral valve repair with MitraClip® between May 2010 and January 2011. Thirty-three consecutive patients (57.6% male; age 77.8 ± 6.7 years) were enrolled and treated with either 1 (n = 7; 21.2%), 2 (n = 20; 60.6%), 3 (n = 4; 12.1%), or 4 (n = 2, 6.1%) clips. Grading of MR was performed by two-dimensional transesophageal echocardiography (2D-TEE) prior to TEE-guided clipping and before discharge. MR was classified as functional in 23 (69.7%) and organic in 10 (30.3%) of the patients with MR-grade ≥ 3+ in 32 (97%) and = 4 in 1 patients (3%) before repair. Reduction in MR grade to grade ≤1+ was achieved in 81.7% and to 2 in 12.1% (P = 0.00072). Invasive pulmonary artery systolic pressure (PAPsyst) and pulmonary capillary wedge pressure (PCWP) v-wave decreased from 59.2 ± 18.6 to 46.9 ± 15.3 mmHg (P = 0.00014) and 21.2 ± 6.7 to 8.0 ± 3.3 mmHg (P = 0.0093), respectively, as measured immediately after clipping. Functional NYHA class improved from mean 3 (range 3 [90.9%] to 4 [9.1%]) to 2 in 84.9% (P = 0.00081) as obtained at discharge. Mitral valve repair with MitraClip® using multiple clips is appropriate and safe in unselected patients resulting in reduced MR with positive impact on short-term functional capacity.
    Journal of Interventional Cardiology 12/2011; 25(2):180-9. DOI:10.1111/j.1540-8183.2011.00688.x · 1.18 Impact Factor
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    M Janda · O Simanski · J Bajorat · B Pohl · G F E Noeldge-Schomburg · R Hofmockel ·
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    ABSTRACT: We developed a closed-loop system to control the depth of anaesthesia and neuromuscular blockade using the bispectral index and the electromyogram simultaneously and evaluated the clinical performance of this combined system for general anaesthesia. Twenty-two adult patients were included in this study. Anaesthesia was induced by a continuous infusion of remifentanil at 0.4 μ−1.min−1 (induction dose) and then 0.25 μ−1.min−1 (maintenance dose) and propofol at 2−1 3 min later. The combined automatic control was started 2 min after tracheal intubation. The depth of anaesthesia was recorded using bispectral index monitoring using a target value of 40. The target value of neuromuscular blockade, using mivacurium, was a T1/T10 twitch height of 10%. The precision of the system was calculated using internationally defined performance parameters. Twenty patients were included in the data analysis. The mean (SD) duration of simultaneous control was 129 (69) min. No human intervention was necessary during the computer-controlled administration of propofol and mivacurium. All patients assessed the quality of anaesthesia as ‘good’ to ‘very good’; there were no episodes of awareness. The mean (SD) median performance error, median absolute performance error and wobble for the control of depth of anaesthesia and for neuromuscular blockade were −0.31 (1.78), 6.76 (3.45), 6.32 (2.93) and −0.38 (1.68), 3.75 (4.83), 3.63 (4.69), respectively. The simultaneous closed-loop system using propofol and mivacurium was able to maintain the target values with a high level of precision in a clinical setting. You can respond to this article at
    Anaesthesia 09/2011; 66(12):1112-20. DOI:10.1111/j.1365-2044.2011.06875.x · 3.38 Impact Factor
  • U.X. Kaisers · A. Welker · Th. Busch · A. Schleppers · F. Hokema · J. Bajorat · G. Nöldge-Schomburg ·
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    ABSTRACT: Introduction: Implementation of the German DRG system induced an increasing workload that led to a supply and demand imbalance in the hospital staff sector. The aim of this study was to investigate the current job situation at German university departments of anaesthesiology. Participants and methods: Under the supervision of the German Society of Anaesthesiology and Intensive Care Medicine and with the support of the Professional Association of German Anaesthetists, a survey of 39 university anaesthesiology chairs was conducted between December 2010 and February 2011. Results: The questionnaire return rate was n=36 (92 %). An inadequate personnel budget was reported by 39 %, and 33 % had vacant staff positions at the time of the survey. In most departments (81 %), the vacancies resulted from fluctuations, and in 50 % of the cases it took an average of more than six weeks to effect replacement. On average, each department had a deficit of 2.8 physicians per month. 75 % compensated increased workload with extra work, and 58 % transferred staff from teaching and research to medical care. In consequence, 53 % reported negative effects on medical training. Delegation to nursing staff was undertaken by 17 % while 8 % employed locum doctors. 25 % predicted further requirements over the middle term. Continuing personnel problems in the near future were anticipated by 56 %. Conclusions: On average, personnel deficits in departments of anaesthesiology are still moderate and compensated primarily by extra work or transferring teaching and research staff to medical care in German universities. Delegation of anaesthesiological tasks and the hiring of locum doctors remains the exception. Adequate budgets and payment, together with an attractive working environment and reliable qualification programmes are needed to improve staff shortfall, and reduce the need for delegation or locum doctors.
    Anasthesiologie und Intensivmedizin 09/2011; 52(9):708-719. · 1.09 Impact Factor

Publication Stats

1k Citations
178.60 Total Impact Points


  • 2001-2014
    • University of Rostock
      • • Faculty of Medicine
      • • Klinik und Poliklinik für Anästhesiologie und Intensivtherapie
      Rostock, Mecklenburg-Vorpommern, Germany
  • 1996-1997
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany