American journal of therapeutics
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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.
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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.