Thomas Schilling

Thomas Schilling
University Hospital Magdeburg · Department of Anesthesiology

MD, PhD, DEAA

About

98
Publications
27,446
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
2,846
Citations
Citations since 2017
19 Research Items
1713 Citations
2017201820192020202120222023050100150200250300
2017201820192020202120222023050100150200250300
2017201820192020202120222023050100150200250300
2017201820192020202120222023050100150200250300
Introduction
Thomas Schilling currently works at the Department of Anesthesiology, University Hospital Magdeburg. Thomas does research in Anaesthetics, Cardiothoracic Surgery and Respiratory Medicine. Their current project is 'Pharmacokinetics of volatile anesthetics'.
Additional affiliations
May 2005 - December 2009
Uppsala University
Position
  • PhD Student
September 2001 - present
Otto-von-Guericke-Universität Magdeburg
Position
  • Professor (Assistant)
September 2001 - December 2016
Otto-von-Guericke-Universität Magdeburg
Position
  • Professor (Assistant)
Education
November 1987 - September 1993
University of Greifswald
Field of study
  • Medicine

Publications

Publications (98)
Chapter
One-lung ventilation is required for thoracic surgery interventions; however, it can impair ventilation/perfusion (VA/Q) matching, thus putting the patient at increased risk for hypoxemia that might compromise the overall outcome. Both anesthetic and surgical management may influence the pulmonary and systemic reaction. Concerning the anesthetic ma...
Article
Background: Previous studies have established the role of various tissue compartments in the kinetics of inhaled anesthetic uptake and elimination. The role of normal lungs in inhaled anesthetic kinetics is less understood. In juvenile pigs with normal lungs, the authors measured desflurane and sevoflurane washin and washout kinetics at three diff...
Article
Background Kinetics of the uptake of inhaled anesthetics have been well studied, but the kinetics of elimination might be of more practical importance. The objective of the authors’ study was to assess the effect of the overall ventilation/perfusion ratio ( .VA/.Q ), for normal lungs, on elimination kinetics of desflurane and sevoflurane. Methods...
Article
Zusammenfassung Das Management der Ein-Lungen-Ventilation (ELV) beinhaltet mehrere Herausforderungen. Diese umfassen die adäquate Oxygenierung und Ventilation und den Schutz der Lunge vor pathophysiologischen Noxen zur Vermeidung postoperativer pulmonaler Komplikationen. Während der ELV wird die Belüftung des zu operierenden Lungenflügels durch ver...
Article
BACKGROUND Remote ischemic preconditioning (RIP) may protect target organs from ischemia – reperfusion injury, however, little is known on pulmonary effects of RIP prior to, immediately after and several hours after one-lung ventilation (OLV). The present randomized, controlled, animal experiment was undertaken to analyze these issues. METHODS Aft...
Article
Full-text available
Purpose of Review Remote ischemic preconditioning (RIP) has been demonstrated to protect against ischemia-reperfusion-injury in different target organs. The mechanisms that eventually lead to these protective effects have been investigated in depth but are not yet fully elucidated. Although the effects of RIP seem to be promising in animal experime...
Article
Purpose: Remote ischemic preconditioning (RIP) may protect remote organs from ischemia-reperfusion-injury (IRI) in surgical and non-surgical patients. There are few data available on RIP and lung function, especially not in healthy volunteers. The null-hypothesis was tested that RIP does not have an effect on pulmonary function when applied on hea...
Article
Full-text available
Background The aim of our study was the identification of genetic variants associated with postoperative complications after cardiac surgery. Methods We conducted a prospective, double-blind, multicenter, randomized trial (RIPHeart). We performed a genome-wide association study (GWAS) in 1170 patients of both genders (871 males, 299 females) from...
Article
Full-text available
Durch die Leitstelle wird der Hausarzt zu einem 56-jährigen Patienten mit der Diagnose „Atemnot“ gerufen. Bei seinem Eintreffen findet der Arzt einen nach Luft ringenden Patienten mit aufgestützten Armen, am offenen Fenster sitzend, mit einem Dosieraerosol in der Hand vor.
Article
Full-text available
This article contains data on experimental endpoints of a randomized controlled animal trial. Fourteen healthy piglets underwent mechanical ventilation including injurious one-lung ventilation (OLV), seven of them experienced four cycles of remote ischemic preconditioning (RIP) on one hind limb immediately before OLV, seven of them did not receive...
Article
Background: One-lung ventilation (OLV) may result in lung injury due to increased mechanical stress and tidal recruitment. As a result, a pulmonary inflammatory response is induced. The present randomized, controlled, animal experiment was undertaken to assess the effects of remote ischemic preconditioning (RIP) on diffuse alveolar damage and immu...
Article
Full-text available
Background: Remote ischemic preconditioning (RIPC) has been suggested to protect against certain forms of organ injury after cardiac surgery. Previously, we reported the main results of RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study, a multicenter trial randomizing 1403 cardiac surgery patients receiving either RIPC or sham-RIP...
Article
Full-text available
Background: Transfusion of blood products and mechanical ventilation with injurious settings are considered risk factors for postoperative lung injury in surgical Patients. Methods: A systematic review and individual patient data meta-analysis was done to determine the independent effects of peri-operative transfusion of blood products, intra-op...
Article
Background: Increasing numbers of patients with obstructive lung diseases need anesthesia for surgery. These conditions are associated with pulmonary ventilation/perfusion (VA/Q) mismatch affecting kinetics of volatile anesthetics. Pure shunt might delay uptake of less soluble anesthetic agents but other forms of VA/Q scatter have not yet been exa...
Article
Zusammenfassung In der anästhesiologischen Praxis ist das Thoraxtrauma eine große Herausforderung. Verletzungen von Atemwegen, Lunge, Zwerchfell, Herz und großen thorakalen Gefäßen sind die vorherrschenden Probleme. Art und Ausmaß des chirurgischen Eingriffs sowie Wirkungen von Anästhetika und mechanischer Ventilation auf die pulmonale und kardiale...
Article
Full-text available
Background: Combined epidural analgesia (EA) and patient controlled analgesia (PCA) for postoperative pain control after total knee arthroplasty (TKA) is well established. Previous studies demonstrated the effectiveness of femoral nerve block (FNB) in combination with PCA. This study compares clinical efficiency and adverse events of pain therapy o...
Conference Paper
Full-text available
One-lung ventilation (OLV) results in alveolar injury due to increased mechanical stress, atelectasis formation, and tidal recruitment [1]. An inflammatory response is induced in the ventilated lung characterized by leukocyte recruitment and neutrophil dependent tissue destruction. Remote ischemic preconditioning (RIP), in which short episodes of i...
Conference Paper
Full-text available
The pharmacokinetics of desflurane (DES) at 1MAC is impaired by methacholine (MCh) induced ventilation/perfusion (VA/Q) mismatch [1]. The rise and decline of the arterial concentrations were decreased by bronchoconstriction during uptake and elimination. DES has the lowest solubility of modern volatile anesthetics (0.35 in pig blood) followed by se...
Conference Paper
Full-text available
The main factors determining alveolar and subsequent blood concentrations of inhaled anesthetics are alveolar ventilation and pulmonary perfusion (VA/Q), the latter essentially equal to cardiac output. The changes of uptake and elimination of a volatile based on uneven distribution of ventilation and/or perfusion have been demonstrated [1]. The sol...
Article
Full-text available
Modern thoracic surgery with its emerging focus on minimally invasive techniques requires intraoperative one-lung ventilation to achieve optimal surgical exposure. The double-lumen tube has been considered to be the golden standard for almost 60 years; however, new indications and surgical techniques in thoracic, cardiac, esophageal and ventral spi...
Article
Full-text available
Since the first accounts of empyema treatment by Hippocrates of Kos, who pioneered surgical procedures of the chest wall and the emergence of thoracic surgery during the late 19th and early 20th century specifically to develop treatment strategies for tuberculosis, chest wall resection and reconstruction has become a mainstay of septic and oncologi...
Article
In daily practice, acute and chronic pulmonary diseases are common issues presenting to the anesthetist. Respiratory physiology in general is affected by both general and regional anesthesia, which results in an increased number of perioperative complications in pulmonary risk patients. Therefore, anesthetic management of patients with bronchial as...
Article
Background: Protective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We inves...
Article
Full-text available
Background: It is widely accepted that manifestations of pain cannot be detached from the case history, accompanying diseases, and the individual medication profile. An indirect association between pain and aggression (due to psychosis) as a cause of administration of neuroleptics has not been described yet. Aim & method: Here we report the connect...
Article
Full-text available
BACKGROUND: In Germany, more than one million people use benzodiazepines on a regular basis. The majority of them is older than 60 years and take low-dose benzodiazepines for sleep disorders. This does not necessarily induce tolerance, but may result in problems such as falling, seizures or delirium if benzodiazepines are discontinued or taken on a...
Article
Full-text available
The data of a corresponding animal experiment demonstrates that nebulized methacholine (MCh) induced severe bronchoconstriction and significant inhomogeneous ventilation and pulmonary perfusion (V̇A/Q̇) distribution in pigs, which is similar to findings in human asthma. The inhalation of MCh induced bronchoconstriction and delayed both uptake and e...
Article
Full-text available
Background: Remote ischemic preconditioning (RIPC) is reported to reduce biomarkers of ischemic and reperfusion injury in patients undergoing cardiac surgery, but uncertainty about clinical outcomes remains. Methods: We conducted a prospective, double-blind, multicenter, randomized, controlled trial involving adults who were scheduled for electi...
Article
Full-text available
Recent studies show that intraoperative mechanical ventilation using low tidal volumes (VT) can prevent postoperative pulmonary complications (PPCs). The aim of this individual patient data meta-analysis is to evaluate the individual associations between VT size and positive end-expiratory pressure (PEEP) level and occurrence of PPC. Randomized con...
Article
Full-text available
The mean age of patients presenting for thoracic surgery is rising steadily, associated with an increased demand for thoracic surgical treatments by geriatric patients. With increasing age, physiologic changes and comorbidities have to be considered. Thoracic anesthesia for elderly patients requires greater specific knowledge. Respiratory mechanics...
Article
Background Lung injury is a serious complication of surgery. We did a systematic review and meta-analysis to assess whether incidence, morbidity, and in-hospital mortality associated with postoperative lung injury are affected by type of surgery and whether outcomes are dependent on type of ventilation. Methods We searched MEDLINE, CINAHL, Web of S...
Article
Full-text available
The thoracic surgical patient is at special risk for increased postoperative pulmonary complications, such as atelectasis, impaired lung function and pneumonia, as well as acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) with high mortality after lung resections. One-lung ventilation (OLV) induces proinflammatory responses esp...
Data
Dynamic computed tomography scan during OLV with V T = 10 ml/kg without preceding ARM. Please note the shearing and stretching of the most dependent parts in the lower ventilated lung
Conference Paper
Full-text available
/Volumes/HDD/Thomas/Eigene Dokumente/Eigene Dokumente und Papiere/Forschung-Publikation/Kinetics of Volatile Uptake/Publikation-Kinetics of Volatile Uptake/Kretzschmar Abstract DAC 2014.docx
Article
Full-text available
The mismatching of alveolar ventilation and perfusion (VA/Q) is the major determinant of impaired gas exchange. The gold standard for measuring VA/Q distributions is based on measurements of the elimination and retention of infused inert gases. Conventional MIGET (multiple inert gas elimination technique) uses gas chromatography (GC) to measure the...
Article
Full-text available
Background: Acute lung injury after thoracic surgery relates to alveolar inflammation induced by one-lung ventilation (OLV) and surgical manipulation. However, alveolar recruitment manoeuvres (ARM), conventional ventilation, and airway manipulation may increase alveolar trauma. This study evaluates pulmonary immune effects of these co-factors in a...
Article
Die Behandlung postoperativer Schmerzen ist ein zentrales Problem bei thoraxchirurgischen Patienten. Die Pathophysiologie der Entstehung des Schmerzes ist komplex, da das chirurgische Vorgehen, die Lokalisation und Komplexitat des Eingriffs, die ungunstige Lagerung des Patienten sowie individuelle Faktoren seine Auspragung bedingen. Trotz der Anwen...
Article
Full-text available
Transient ischaemia of non-vital tissue has been shown to enhance the tolerance of remote organs to cope with a subsequent prolonged ischaemic event in a number of clinical conditions, a phenomenon known as remote ischaemic preconditioning (RIPC). However, there remains uncertainty about the efficacy of RIPC in patients undergoing cardiac surgery....
Article
Background The increased tidal volume (V(T)) applied to the ventilated lung during one-lung ventilation (OLV) enhances cyclic alveolar recruitment and mechanical stress. It is unknown whether alveolar recruitment maneuvers (ARMs) and reduced V(T) may influence tidal recruitment and lung density. Therefore, the effects of ARM and OLV with different...
Article
Full-text available
One-lung ventilation (OLV) results in alveolar proinflammatory effects, whereas their extent may depend on administration of anesthetic drugs. The current study evaluates the effects of different volatile anesthetics compared with an intravenous anesthetic and the relationship between pulmonary and systemic inflammation in patients undergoing open...
Article
Full-text available
The increased tidal volume (V(T)) applied to the ventilated lung during one-lung ventilation (OLV) enhances cyclic alveolar recruitment and mechanical stress. It is unknown whether alveolar recruitment maneuvers (ARMs) and reduced V(T) may influence tidal recruitment and lung density. Therefore, the effects of ARM and OLV with different V(T) on pul...
Article
Full-text available
Mechanical stress during one-lung ventilation (OLV) results in lung injury. This study compared the effects of mechanical ventilation, OLV, and surgical manipulation on diffuse alveolar damage (DAD) after application of different anesthetic regimens. Prospective, randomized, controlled, blinded animal experiment. University hospital. Twenty-one pig...
Article
Full-text available
The implantation of cardiac resynchronization/defibrillation devices (CRT-Ds) increasingly is used in patients with congestive heart failure and left bundle-branch block. There are no data on the effects of anesthesia and surgery on outcome after implantation. A retrospective, observational study; postoperative survey. University hospital. Three hu...
Article
Full-text available
One-lung ventilation (OLV) exposes the dependent lung to increased mechanical stress which may affect the postoperative course. This study evaluates regional pulmonary gas/tissue distribution in a porcine model of OLV. Nine anaesthetized and mechanically ventilated (V(T)=10 ml kg(-1), FI(O(2))=0.40, PEEP=5 cm H(2)O) pigs were studied. After lung se...
Article
Full-text available
One-lung ventilation (OLV) increases mechanical stress in the lung and affects ventilation and perfusion (V, Q). There are no data on the effects of OLV on postoperative V/Q matching. Thus, this controlled study evaluates the influence of OLV on V/Q distribution in a pig model using a gamma camera technique [single-photon emission computed tomograp...
Article
Full-text available
One-lung ventilation (OLV) induces a pro-inflammatory response including cytokine release and leucocyte recruitment in the ventilated lung. Whether volatile or i.v. anaesthetics differentially modulate the alveolar inflammatory response to OLV is unclear. Thirty patients, ASA II or III, undergoing open thoracic surgery were randomized to receive ei...
Article
Full-text available
The authors report the exceptional case of an adult with Niemann-Pick Type B and coronary artery disease who underwent elective coronary artery bypass graft (CABG) surgery. The anesthetic management for this procedure was planned carefully because impaired perfusion of the splanchnic region resulting from anesthetic drugs, mechanical ventilation, a...
Article
Full-text available
Bleeding disorders and hemorrhages cause considerable morbidity and mortality in cardiac surgical patients. Possible thromboembolic complications make the use of recombinant activated factor VII (rFVIIa) in the treatment of bleeding after cardiac surgery controversial. Case Reports: We describe 2 patients who experienced intractable bleeding after...
Conference Paper
One-lung ventilation (OLV) during thoracic surgery is an established procedure. OLV and surgical manipulation may result in mechanical stress of the lungs leading to atelectasis formation and shunt increase resulting in a ventilation/perfusion mismatch. The aim of the study was to assess the influence of OLV on postoperative ventilation-perfusion d...
Conference Paper
One-lung ventilation (OLV) with normal tidal volumes (10ml/kg) may result in biotrauma of the ventilated lung which is characterized by increased concentrations of proinflammatory cytokines in the bronchoalveolar lavage fluid [1]. The effects of inhalational or intravenous anesthetic drugs on the immunological response to OLV are unclear. A prospec...