Translational Anesthesiology

In everyday clinical practice, there is regularly a change in the anesthesiologist in charge during anesthesia, with the need for a handover that includes all relevant information regarding the patient and the status of the surgery. Retrospective analyses show that such changes have a negative impact on patient outcome. There are recommendations to perform this handover according to a structured scheme. Whether such a scheme in the sense of a checklist has an influence on patient outcome has not yet been investigated in this setting.

The aim of this study is to collect information on the feasibility and data on effect size and associated measures of dispersion of a confirmatory, prospective, multicenter, before-and-after study that answers the question:Does a standardized checklist for intraoperative anesthesiology patient handoffs reduce the rate of postoperative complications?

(Study type: Prospective, monocentric, before-after observational study).

(Julia Sander; PhD student: Timon Streiter)

In the DFG-funded project "Heme oxygenase as a therapeutic target in anti-HLA antibody-mediated graft vasculopathy", we are investigating the impact of the anti-inflammatory enzyme HO-1 on the development and progression of graft vasculopathy. In various in vitro experiments, we modulate the activity and expression level of HO-1 in endothelial cells to visualize its effects on monocyte adhesion and transmigration in subsequent functional assays. By screening various adhesion molecules at the molecular biology and protein biochemistry levels, we seek to better understand the underlying mechanism. To verify our collected results in vivo, we have established a heterotopic aortic grafting model in mice. Here, a piece of aorta is transplanted between genetically different mouse strains and graft vasculopathy is induced by application of the appropriate antibody. This extremely complex animal model allows us to investigate the protective effect of HO-1 and further therapeutic approaches.

(Laura Kummer)

Cardiovascular complications are one of the most common causes of perioperative morbidity and mortality after noncardiac surgery. The underlying mechanisms of perioperative plaque rupture are incompletely understood. However, from previous studies in atherosclerotic mice, immunological processes occurring during surgery condition the progression and destabilization of preexisting atherosclerotic plaques. Furthermore, we observed in a clinical study that preoperative low regulatory T-cell levels correlate with an increased risk of perioperative cardiovascular events.

The aim of this project is to investigate a possible causal relationship of preoperative regulatory T cell levels with perioperatively increasing atherosclerotic plaque vulnerability in a mouse model of perioperative stress, as well as to derive the mechanistic basis using histomorphometric, cell and molecular biology studies.

(Jessica Handke)

In the perioperative setting, high volumes of unstructured data are generated on each treatment day. The utilization of such data sources from standard care and their integration with specific research data collected in the course of studies forms the basis for a high-resolution characterization of the perioperative treatment pathway. In the KoMed study, partners at Heidelberg University Hospital (the Department of General, Visceral, and Transplant Surgery, the Institute of Medical Biometry and Informatics, the Department of Medical Information Systems, and the Center for Information and Medical Technology), as well as partners from industry(Mint Medical GmbH, Philips Medizin-Systeme Böblingen GmbH, KARL STORZ SE & Co. KG, and phellow seven GmbH) are preparing such an extensive, detailed data set for further processing in science for the first time. The concerted collection is made possible by the integrated IT environment of the new building of the Surgical Clinic at Heidelberg University Hospital. The emerging pipeline for the multimodal data sources will provide the basis for work with machine learning methods at the Department of Anesthesiology. The goal of the project is to develop clinical discrimination support in the form of an algorithmic tool for risk stratification and prediction of postoperative complications.

(Project leader Jan Larmann, M.D., Ph.D., Deputy project leader Prof. Pascal Probst, M.D.)

(Researchers: Christian Niklas, M.D., Sachin Kumar, Laura Kummer, Balavivek Sivanantham).

• Der Kognitive medizinische Assistent - Kurzfilm

Liver transplantation is often the only curative treatment option for end-stage liver disease. In view of the scarcity of organs and the increased morbidity and mortality for the patient associated with retransplantation, the avoidance of complications in the course of (liver) transplantation is of particular importance.

An extremely feared complication is thrombosis of the hepatic artery, portal vein and vena cava. A number of risk factors have been identified and described in the literature. However, it has not yet been investigated whether the substitution of certain clotting factors (prothrombin complex concentrate, or PPSB, and fibrinogen concentrate) in the perioperative period plays a role in the development of thrombosis of the hepatic artery, portal vein, or inferior vena cava. Substitution of these blood products is often necessitated by impaired synthesis function due to underlying liver disease.

This is being investigated in a monocentric, retrospective study to further analyze the possible, above-mentioned, relationship and thus contribute to a better understanding of perioperative thrombotic complications in liver transplantation.

(Dr. med. Sarah Dehne; PhD student: Carlo Riede)

An elevated inspiratory oxygen concentration (FiO2) is commonly used in anesthesia, critical care, and emergency medicine. During general anesthesia, the patient is ventilated with a FiO2 between 30% and 100%, depending on the patient's need, the type of surgical procedure, and the anesthesiologist's preference. In this study, we investigate whether a high FiO2 during elective oncologic surgery influences the further course of disease in tumor patients. 1084 patients with colorectal, pancreatic, and hepatocellular carcinoma who underwent surgery at the Department of Surgery at Heidelberg University Hospital between 01/2009 and 12/2016 were included in the study. The primary endpoint is tumor-free survival during the observation period from index surgery to the longest available follow-up. We calculated the mean FiO2 value during surgery for each patient and analyzed data on further disease progression. Patients are divided into two groups according to their FiO2 values and compared in terms of tumor-free survival using Kaplan-Meier analysis.

(Sarah Dehne, MD; PhD student: Verena Spang)

Up to 8 to 13% of non-cardiac surgery patients suffer perioperative cardiovascular complications, some of them severe, such as myocardial infarction, arrhythmias or pulmonary embolism, which account for more than two-thirds of perioperative mortality.

Various studies have already shown the reappearance of perioperatively increased platelet function under aspirin therapy (aspirin resistance). Whether this observation is related to above mentioned cardiovascular events is unclear so far.

In this prospective clinical observational study, vascular surgery patients will now be used to investigate whether the occurrence of perioperative aspirin resistance is associated with the occurrence of small myocardial injury (myocardial injury after non-cardiac surgery, or MINS) and therefore also with increased 30-day mortality. In addition, we will test whether newly developed aspirin resistance can be reversed by in vitro addition of aspirin.

This project is funded by the B. Braun Foundation.

(Dr. med. Sarah Dehne; PhD student: Christian Heck)