American journal of therapeutics
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Zolpidem is a nonbenzodiazepine hypnotic with a favorable adverse effect profile. There are single reports of respiratory decompensation associated with zolpidem overdose. ⋯ Supportive management led to a complete recovery of neurologic function. Acute zolpidem overdose should be considered in the differential diagnosis of coma with absent brainstem reflexes.
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Nausea and vomiting are 2 of the most upsetting adverse reactions of chemotherapy. Current guidelines propose 5-hydroxytryptamine3 (5-HT3) receptor antagonists as a pharmacologic intervention for acute and delayed nausea and vomiting [chemotherapy-induced nausea and vomiting (CINV)] associated with moderately and highly emetogenic chemotherapy. Meanwhile, both postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting are challenging situations after surgeries and procedures. ⋯ There has been mounting interest in exploring integrative medicine, either acupuncture or acustimulation of P6 (Nei-Kuwan), to complement the western medicine for prevention and management of nausea and vomiting. The potential application of cannabinoids, either alone or in combination with other agents of different mechanism, could contribute further to improve outcome in CINV. Implementation of future treatment guidelines for more effective management of CINV and PONV could certainly improve the efficacy and outcome of cancer and postoperative care.
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Review Case Reports
Effectiveness of full agonist opioids in patients stabilized on buprenorphine undergoing major surgery: a case series.
A review of the medical literature failed to reveal clear, agreed-upon guidelines for practitioners on the postoperative provision of full agonist opioids for patients maintained on buprenorphine. Some controversy appears to exist about whether to maintain patients on their buprenorphine regimen up to the time of surgery. ⋯ Postoperative pain was adequately controlled using full agonist opioids according to self-report and physician assessment. The observations from this case series lend support to the practice of maintaining stable buprenorphine dosing for patients who require major surgery.
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A review of the history, incidence, presentation, pathophysiology, and treatment of propofol infusion syndrome.
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Labor analgesia researchers have pursued better and safer ways to provide pain relief in labor. Although some pharmacologic investigations have focused on alternative mechanisms to target and medications to employ, a large part of the recent obstetric anesthesiology literature has contributed toward the safety and efficacy of techniques dependent on traditional therapeutics, specifically local anesthetics given through a neuraxial anesthetic technique. Investigators have worked to demonstrate and remove doubts that neuraxial anesthesia can be a safe method of labor analgesia. ⋯ To avoid excessive dosages, clinical up-down sequential allocation experiments identified the minimum amounts of local analgesia needed. Modifications to the administration of drug allowed total doses to be further reduced. This historical overview highlights some of these important advances in the present and recent past of neuraxial labor analgesia, and it traces how desired outcomes are being achieved with less and less total drug.