A brief, high-dose remifentanil infusion partially reverses neuropathic pain in a subgroup of post herpetic neuralgia patients.

Mechanism-based therapy for chronic pain is desperately needed. Recent basic science research demonstrated that remifentanil can reverse long-term potentiation at C-fiber synapses in the dorsal horn of rats. In this exploratory, single group study, patients with chronic post-herpetic pain were treated with a single, one-hour, high-dose remifentanil infusion. The mean overall change of pain intensity seven days after treatment was -18 (-7.5; -28.5, 95%CI, p<0.001) points on the numeric rating scale (0-100) (-33 (±11) points amongst responders only). Eleven of 20 patients responded to treatment (≥30% reduction in pain), the mean relative reduction in pain from baseline amongst responders was 61.0%. These promising preliminary results suggest that a mechanism-based reversal of chronic pain may be impending.

Heparin-induced effects of prothrombin complex concentrates in thromboelastometry.

BACKGROUND: Prothrombin complex concentrates (PCC) are currently used to treat congenital or acquired coagulation factor deficiency. In case of serious bleeding caused by new oral anticoagulant agents, reversing treatment with PCC is under debate. PCC preparations mostly contain heparin to prevent thromboembolic events. In factor VIII and IX deficient plasma, Takeyama et al. observed in vitro a heparin effect at appropriate concentrations of PCCs. The aim of the present experiment was to investigate the heparin effect of four factor-PCC at clinically relevant concentrations in whole blood. In an in vitro experiment, we compared the PCC preparation used in the experiments of Takeyama with a high heparin content to a new heparin-free PCC preparation. METHOD: After ethics committee approval and written informed consent, the citrated whole blood was obtained from ten healthy volunteers. We tested heparin-containing Prothromplex(®) and heparin-free Cofact(®) at concentrations of 0.31, 0.63, and 1.25 IU/ml. Protamine was added to another set of samples (1:1 heparin:protamine). We used the NATEM test in the rotational thromboelastometer ROTEM(®). RESULTS: In the heparin PCC preparation, we observed a significant (p < 0.001) concentration-dependent prolongation in CT and CFT, even at the lowest concentration. MCF was also significantly reduced. The heparin effect was reversible by protamine. The heparin-free PCC did not affect the onset of coagulation. The interpretation of the alpha-angle showed no increased thrombus formation in heparin-free PCC preparation. CONCLUSION: Our results extend the report of Takeyama et al. At clinically relevant PCC concentrations, the heparin effect was significant in thromboelastometry. The heparin content of PCCs should be considered in clinical routine.

[Inhalation injury--epidemiology, diagnosis and therapy]. / Das Inhalationstrauma - Epidemiologie, Diagnostik und Therapie.

OBJECTIVE: Inhalation injury is a vitally threatening medical syndrome, which might appear in patients with or without burn injuries. Thus, knowledge about development, diagnosis and treatment of inhalation injury should be available for each physician working in an intensive care unit. METHODS: This review starts with the causal and formal pathogenesis of inhalation injuries. Furthermore, diagnosis and treatment in the critical care setting are presented, followed by the discussion of possible complications. Specific intoxications such as carbon monoxide are due to their importance separately discussed. CONCLUSIONS: Inhalation injury present with an attributable excess mortality and thus worsen the prognosis of burned patients. New insights into the pathogenesis of inhalation injury, however, have led to improved therapeutic possibilities with improved outcome. Necessary prerequisites are a timely diagnosis and restrictive volume management, especially in patients with extensive burns. Prospective studies are needed to be able to answer the many emerging questions.

The effects of high molecular weight hydroxyethyl starch solutions on platelets.

Physicochemical characteristics of hydroxyethyl starch (HES) molecules determine their side effects on hemostasis. Our aim in the present experiments was to test the antiplatelet effect of novel high molecular weight HES. Citrated whole blood was hemodiluted in vitro (0% and 20%) with either HES 550 (Hextend), HES 600 (6%Hetastarch-Baxter), HES 200 (Elohäst), or the solvent of Hextend in its commercially available solution. The availability of glycoprotein IIb-IIIa was assessed on nonstimulated and on agonist-induced platelets using flow cytometry. Glycoprotein IIb-IIIa availability increased significantly after hemodilution with Hextend and its solvent by 23% and 24%, respectively, but decreased in the presence of 6% Hetastarch-Baxter and Elohäst by 18% and 15%, respectively, with no significant difference between the latter two colloids. This study shows that Hextend does not inhibit platelet function as anticipated by its high molecular weight and degree of substitution. The unexpected platelet stimulating effect of Hextend is unique among the currently available HES preparations and may, at least in part, be induced by its solvent containing calcium chloride dihydrate (2.5 mmol/L). The platelet-inhibiting effect of 6%Hetastarch-Baxter was not significantly different from that of medium molecular weight HES 200.