Search Results (121)

Ovine coenurosis, caused by the larval stage of Taenia multiceps (Coenurus cerebralis), is a parasitic disease that affects the central nervous system of livestock. While diagnosis traditionally relies on clinical signs, imaging, and postmortem examination, electroencephalography (EEG) remains underutilized despite its potential to detect brain abnormalities. This case report describes EEG and quantitative EEG (qEEG) findings in a 2-year-old sheep presenting with clinical signs suggestive of a chronic focal encephalopathy (ataxia, head tilt and circling) associated with lethargy and progressive weight loss. Computed tomography (CT) confirmed a single, discretely bilobate intra-axial cystic lesion within the left cerebral hemisphere, with a severe mass effect, marked deformation and displacement of the ventricular system, compression of the thalamic structures, and contralateral deviation of the median line. A solitary parasitic cyst with no lesion in the right hemisphere was subsequently confirmed at necropsy and on histopathology. Under ketamine–diazepam sedation, both EEG recordings showed a continuous, delta-dominant background consistent with the anesthetic protocol. Epoch-wise asymmetry indices with bootstrap confidence intervals distinguished an unstable component (which reversed in hemispheric sign between recordings) from a reproducible one confined to the occipital derivations, where the asymmetry lay over the right hemisphere in both recordings in every band except delta. This reproducible preponderance was contralateral to the cyst, over a hemisphere in which no structural lesion was demonstrable either on imaging or at necropsy, and absolute powers indicated that it arose principally from attenuation of the signal recorded over the diseased hemisphere. These findings provide the first electrophysiological characterization of ovine coenurosis and show that in the presence of a severe mass effect, the side of the surface qEEG abnormality may not indicate the side of the lesion (an electrophysiological false localizing sign described in human patients but not previously in a ruminant). EEG therefore reflects the functional brain disturbance caused by Coenurus cerebralis but should be regarded as a complement to, rather than a substitute for, cross-sectional imaging in neurolocalization. Full article

Background: Acute brain injury (ABI) is a major cause of mortality and morbidity during extracorporeal membrane oxygenation (ECMO), yet early diagnosis remains challenging because neuroimaging is often impractical in critically ill patients. We evaluated whether quantitative electroencephalography (qEEG) combined with machine learning could identify ABI and predict mortality in patients receiving ECMO. Methods: Consecutive adult ECMO patients who underwent a standardized neuromonitoring protocol with continuous EEG during sedation interruption were retrospectively analyzed. Quantitative EEG features and clinical variables were extracted and used to train multiple machine-learning classifiers with leave-one-subject-out cross-validation. Results: Fifty-seven patients were included (mean age 56 years; 54% male), including 41 supported with venoarterial ECMO, 15 with venovenous ECMO, and one with venoarterial-venous ECMO. ABI occurred in 21 patients (37%), of whom 70% had ischemic injury. Models incorporating qEEG achieved higher point estimates than those using clinical variables alone for ABI detection (best area under the curve (AUC) 0.769, 95% confidence interval (CI) 0.638–0.883, vs. 0.681), although the difference did not reach statistical significance. Frontal theta power and interhemispheric asymmetry were the EEG features most strongly associated with ABI. qEEG features also carried prognostic information for 30-day mortality (best AUC 0.864). Conclusions: Machine-learning analysis of continuous qEEG acquired during standardized sedation interruption may provide a noninvasive bedside approach for identifying ECMO patients at increased risk of ABI and short-term mortality and may help prioritize urgent neuroimaging and neurological intervention. Full article

Tetanus is uncommon in dogs, which are considered relatively resistant to tetanospasmin, and detailed descriptions of the diagnostic evaluation of severe generalized cases remain limited. A 5.5-month-old intact male Miniature Schnauzer was presented four days after a puncture wound to the right pelvic limb. On admission the dog was alert but non-ambulatory, with generalized muscle rigidity, tremors, marked cervical hyperextension, hyperactive spinal reflexes, facial muscle spasms and dysphagia. Together with the wound history and rapid progression, these findings supported a presumptive diagnosis of generalized tetanus, clinically classified as Grade III. Serum collected before tetanus antitoxin administration contained no detectable antibodies against Clostridium tetani neurotoxin. Treatment comprised equine tetanus antitoxin, antimicrobials, multimodal sedation and muscle relaxation, enteral nutrition, intensive nursing and physiotherapy. Needle electromyography on day 10 showed increased insertional activity, positive sharp waves and fibrillation potentials, and continuous spontaneous motor unit activity. Despite patient young age and rapid disease progression, clinical improvement was evident from day 10, and the dog was discharged on day 16, ambulatory and eating voluntarily. This case highlights that severe generalized canine tetanus remains principally a clinical diagnosis, while serial neurological examination, clinicopathological monitoring and electromyography can strengthen diagnostic confidence, characterize disease progression and support clinical management. Full article

Background: Obstructive sleep apnea (OSA) remains under-treated because continuous positive airway pressure, though efficacious, is frequently limited by poor tolerance and adherence. Long considered a purely anatomical disease refractory to drugs, OSA is now understood as the shared endpoint of four measurable endotypes—a collapsible upper airway, poor pharyngeal dilator-muscle responsiveness, high loop gain, and a low arousal threshold—each a distinct pharmacological target. This review synthesizes the mechanistic rationale and clinical evidence for targeting them. Methods: In this narrative review, we searched PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (January 2000 to February 2026) for randomized trials, meta-analyses, and mechanistic endotyping studies, appraising the evidence narratively. Results: Tirzepatide became the first drug approved for OSA, acting through weight loss to reduce obesity-related mechanical loading, and the noradrenergic–antimuscarinic combination AD109 met its primary endpoint in a pivotal phase 3 trial by targeting dilator-muscle activity independently of weight. Both, however, used AHI-based endpoints in clinically defined rather than endotype-selected populations; AD109’s placebo-corrected effect was modest (−4.0 events/h), and 21.2% versus 3.1% of participants discontinued for adverse events. They are therefore best described as mechanism-informed rather than endotype-validated. Carbonic anhydrase inhibition with acetazolamide or sultiame and selected sedating agents address ventilatory instability and a low arousal threshold, while solriamfetol and pitolisant relieve residual sleepiness. Conclusions: Mechanism-informed pharmacotherapy for OSA is now clinically credible, but scalable bedside endotyping, attention to tolerability, and trait-stratified trials are needed before treatment can be called endotype-guided. Full article

Background: Continuous epidural analgesia is widely used for postoperative pain management in small infants. Epidural catheters may be inserted via a caudal-threaded approach or by direct lumbar/thoracic placement; however, comparative data on placement success, clinical use, postoperative analgesic outcomes, and complications remain limited. This study compared these two epidural techniques in small-weight infants undergoing surgery. Methods: This retrospective observational cohort study included all infants admitted to the Neonatal Intensive Care Unit at UPMC Children’s Hospital of Pittsburgh with documented epidural catheter placement in the chart between January 2018 and December 2024. Demographic and perioperative data were extracted from the electronic medical record. Outcomes included technical success of catheter placement; patient, surgical, and epidural characteristics; epidural medications; postoperative pain and sedation scores; opioid consumption; and epidural catheter complications. Results: A total of 104 patients had documentation of 105 epidural catheter placements in the chart; five procedures were unsuccessful in four patients, resulting in 100 successful epidural catheter placements (70 caudal-threaded and 30 direct lumbar/thoracic). Patient and surgical characteristics, postoperative pain and sedation scores, and opioid consumption did not differ significantly between groups. Direct lumbar/thoracic epidural catheter placement required longer procedure times. Patients in the direct lumbar/thoracic epidural group were more likely than those in the caudal-threaded group to receive a ropivacaine/clonidine infusion (47% vs. 4%; p < 0.001) and a programmed intermittent bolus of epidural infusion (60% vs. 3%; p < 0.001). The direct lumbar/thoracic group experienced more postoperative catheter-related complications than the caudal-threaded group (20% vs. 4%; p = 0.02), primarily catheter leakage requiring premature catheter removal. Conclusions: Epidural catheter placement was successful in 96.2% of patients. No statistically significant between-group differences were detected in postoperative pain scores, sedation scores, or opioid consumption between caudal-threaded and direct lumbar/thoracic epidural catheters in small-weight infants (median 3 kg) when placed by a Pediatric Acute Pain Service. Direct lumbar/thoracic epidural catheters were associated with a higher incidence of postoperative catheter leakage and premature catheter removal; however, these complications cannot be attributed solely to the location of epidural catheter insertion. These findings may help clinicians select the most appropriate epidural technique for postoperative pain management in this population. Full article

Background/Objectives: Endovascular thrombectomy (EVT) has transformed the treatment of acute ischaemic stroke due to large-vessel occlusion, yet peri-procedural haemodynamic instability may compromise penumbral perfusion and neurological recovery. We assessed the frequency, determinants and clinical consequences of post-procedural hypotension after EVT. Methods: We retrospectively reviewed 201 consecutive adults who underwent endovascular thrombectomy for anterior-circulation large-vessel occlusion at a single tertiary centre over a period of eight years, from 1 January 2017 to 31 January 2025. Post-procedural hypotension was defined as hypotension requiring initiation of a continuous noradrenaline infusion within 24 h of the procedure. Comorbidities, anaesthetic modality (general anaesthesia [GA] or conscious sedation [CS]), National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores, and in-hospital mortality were recorded. Logistic regression identified independent predictors of hypotension. Results: Fifty-five patients (27.4%) developed post-procedural hypotension. They presented with more severe strokes (NIHSS 16.0 ± 5.0 vs. 13.7 ± 5.0; p = 0.002), had higher NIHSS scores at day 2 (14.0 ± 6.9 vs. 9.4 ± 6.7; p < 0.001) and day 7 (p = 0.003), and displayed markedly higher in-hospital mortality (50.9% vs. 20.5%; p < 0.001). In an ordinal analysis of the day 7 modified Rankin Scale with death coded as 6, hypotension was associated with a shift towards greater disability (common OR 2.57, 95% CI 1.40–4.72; p = 0.002). In an exploratory model, each additional 10 min of door-to-groin time was independently associated with hypotension (adjusted OR 1.10, 95% CI 1.03–1.18; p = 0.003). Independent predictors of hypotension were baseline NIHSS (adjusted OR 1.11 per point, 95% CI 1.04–1.19; p = 0.003) and active malignancy (adjusted OR 2.90, 95% CI 1.04–8.09; p = 0.042). Hypotension occurred with similar frequency under GA and CS (28.6% vs. 24.6%; adjusted OR 1.12, 95% CI 0.54–2.34; p = 0.766). Conclusions: Post-EVT hypotension is common and associated with poorer early neurological recovery and a more than two-fold higher in-hospital mortality rate. Its independent predictors were baseline stroke severity and active malignancy. Patients with severe stroke or active cancer may warrant intensified haemodynamic surveillance after thrombectomy. Procedural delay emerged as the only modifiable predictor identified and warrants prospective evaluation. Full article

Background/Objectives: Mechanical power (MP) quantifies the energy delivered to the respiratory system during ventilation and serves as a promising marker for ventilator-induced lung injury (VILI). According to its original definition by Gattinoni, MP reflects the energy transferred from the ventilator to the respiratory system under conditions of deep sedation, passive breathing, neuromuscular blockade, and volume-controlled ventilation. Its role in coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) remains under investigation. This systematic review aimed to synthesize the available evidence on the association between MP and VILI, complications related to mechanical ventilation (MV), and mortality in adult patients with COVID-19 undergoing invasive mechanical ventilation (IMV). Methods: A systematic review was conducted using PubMed-MEDLINE (Medical Literature Analysis and Retrieval System Online) for studies published in recent years, focusing on adult COVID-19 patients undergoing IMV. Inclusion criteria centered on studies reporting MP and its association with VILI, complications, or mortality. Ten studies met eligibility criteria after screening 356 retrieved articles. Results: Most included studies were retrospective and observational, encompassing critically ill COVID-19 patients. Elevated MP was correlated with more severe outcomes, including increased 28-day mortality, prolonged MV, and weaning failure. Franck et al. demonstrated strong correlations between MP and driving pressure, elastance, and positive end-expiratory pressure, emphasizing the importance of calculation methods. González-Castro et al. identified a threshold of 17 J/min, above which mortality risk increased. Stalla et al. highlighted that dynamic MP reductions during prone positioning were associated with survival. Registry-based analyses confirmed that both magnitude and cumulative exposure above 18 J/min increased intensive care unit mortality. Novel indices combining MP with oxygenation parameters improved prognostic accuracy. While absolute MP at initiation provided limited predictive value, temporal trends and individual components were strongly linked to VILI. Conclusions: Higher MP has been associated with adverse clinical outcomes in patients with COVID-19 receiving invasive mechanical ventilation, supporting its potential role as a prognostic indicator. Its dynamic assessment, thresholds, and integration with ventilatory strategies such as prone positioning enhance risk stratification and may guide individualized, lung-protective ventilation. Continuous monitoring and standardized calculation are recommended to optimize clinical decision-making. Full article

Background/Objectives: Regional anesthesia techniques are increasingly being incorporated into multimodal analgesia for septorhinoplasty. This study compared the postoperative analgesic efficacy and recovery profiles of infraorbital–infratrochlear (ION–ITN) nerve block and transnasal sphenopalatine ganglion (SPG) block techniques. Methods: In this prospective, randomized, double-blind trial, 93 patients undergoing septorhinoplasty received bilateral ION–ITN block (n = 45) or transnasal SPG block (n = 48). The primary outcome was postoperative pain assessed using the Numerical Rating Scale (NRS). Peak postoperative NRS scores at the predefined assessment intervals were evaluated with a linear mixed-effects model adjusted for relevant covariates. Continuous variables are presented as medians (first quartile–third quartile [Q1–Q3]), and categorical variables as numbers (percentages). Secondary outcomes included emergence agitation (Riker Sedation–Agitation Scale (RSAS)), rescue tramadol use, patient satisfaction, and adverse events. Results: Pain scores decreased significantly over time in both groups (p < 0.001). No significant group effect was observed (p = 0.726), and adjusted between-group differences were not significant at any postoperative interval (all p > 0.05). Although the group-by-time interaction showed a trend toward statistical significance (p = 0.053), no meaningful differences in postoperative pain trajectories were observed between the two groups. Median RSAS scores were lower in the SPG group (3 [2,3,4] vs. 4 [3,4], p = 0.04), whereas emergence agitation incidence, tramadol use, patient satisfaction, and adverse events were similar. Conclusions: Within the multimodal analgesic regimen, no statistically significant differences in postoperative pain outcomes were detected between ION–ITN and transnasal SPG block. Because this study was not designed as an equivalence or non-inferiority trial, these findings should be interpreted as an absence of detected differences rather than proof of equivalent analgesic efficacy. Although SPG block was associated with lower agitation scores, this finding suggests reduced agitation severity rather than superior overall analgesic efficacy. Full article

Background: Non-invasive ventilation (NIV) is a well-established approach for preventing endotracheal intubation (ETI) in critically ill patients with acute respiratory failure (ARF). Sedation is frequently used to improve comfort. This study aimed to analyze the impact of sedation during NIV on ETI rates and NIV success in critically ill patients. Methods: We systematically searched in PubMed, EMBASE, MEDLINE, Web of Science, and CENTRAL up to September 2023, including prospective observational studies, retrospective cohort studies (nRCTs), and randomized controlled trials (RCTs). Primary outcomes were NIV success and ETI rates; secondary outcomes were hypotension, bradycardia, 28-day mortality, delirium, and oversedation. Proportions were used for observational studies, odds ratios (OR) for retrospective studies, and risk ratios (RR) for RCTs. Retrospective studies compared intermittent and continuous analgosedation, while RCTs evaluated dexmedetomidine versus other sedatives, including direct comparisons. Results: Four observational studies, 2 retrospective studies, and 7 RCTs (738 patients) were selected. Dexmedetomidine showed increased NIV success (RR = 1.167, 95%C.I. 1.014–1.343, p = 0.032) and reduced ETI rate (RR = 0.553, 95%C.I. 0.405–0.755, p < 0.001), but higher rate of bradycardia (RR = 2.172, 95%C.I. 1.819–4.042, p < 0.001) and hypotension (RR = 2.441, 95%C.I. 1.608–3.706, p < 0.001). nRCTs revealed higher NIV success (Proportion = 0.694, 95%C.I. 0.528–0.912, p = 0.009), moderate ETI rates (Proportion = 0.379, 95%C.I. 0.282–0.511, p < 0.001), and low bradycardia and hypotension rates. Conclusions: Our findings suggest that sedation, particularly dexmedetomidine-based strategies, may enhance NIV success and lower ETI rates. However, dexmedetomidine was also associated with higher rates of bradycardia and hypotension, especially compared with midazolam. To establish the correct sedation strategy, it is important to tailor the drug to the patient, considering its hemodynamic instability, delirium risk, and mortality risk. Full article

Palliative sedation is a key intervention to relieve refractory suffering at the end of life; however, its implementation depends on access to essential medications. This study aimed to evaluate the availability and access to palliative sedation medications and to identify associated barriers among physicians affiliated with the Ecuadorian Association of Palliative Care (ASECUP). A quantitative, cross-sectional study was conducted using a structured, validated questionnaire administered to 82 eligible ASECUP-affiliated physicians. Descriptive and bivariate analyses were performed to assess associations between medication availability and institutional variables. Midazolam was the most frequently used medication (82.0%); however, availability was inconsistent, with only 54.9% reporting constant access. The main barriers identified were regulatory restrictions (53.7%), distribution problems (36.6%), and the absence of clear access policies (41.5%). Administrative difficulties were also common: 40.2% of participants reported modifying clinical protocols due to medication shortages, and 48.8% observed adverse clinical consequences. Significant disparities were found according to the type of institution and level of care, as indicated by chi-square p-values (institution type: p = 0.002; level of care: p < 0.001), with lower medication availability in public and primary care settings. These findings indicate that access to palliative sedation medications in Ecuador is limited by structural and systemic barriers rather than economic factors alone. Improving access requires system-level interventions, including stronger regulatory frameworks, optimized supply chains, and integration of palliative care across all levels of the health system. Ensuring continuous and equitable access to essential medications is essential to reduce preventable suffering and guarantee dignified end-of-life care. Full article

Background and Clinical Significance: Severe pediatric spastic equinovarus may significantly impair positioning, orthotic tolerance, hygiene management, caregiver-assisted mobilization, and assisted standing activities. In children with severe cerebral palsy, clinically meaningful outcomes frequently include reduction in caregiver burden and facilitation of daily care rather than restoration of autonomous gait. Ultrasound-guided cryoneurolysis has recently emerged as a minimally invasive option for focal spasticity management, although procedural workflow and tolerability remain challenging in severe deforming patterns. Case Presentation: We report a CARE-compliant same-patient bilateral technical comparison in a 9-year-old child with severe spastic cerebral palsy and bilateral dynamic equinovarus refractory to intensive rehabilitation and repeated botulinum toxin treatment. Baseline severity was consistent with GMFCS level IV. One lower limb was treated using the proposed posterior single-window ultrasound-guided cryoneurolysis approach through a single posterior proximal-calf window, whereas the contralateral limb underwent a conventional multi-point supine strategy. The posterior single-window approach enabled sequential targeting of multiple motor branches through a single posterior access corridor under continuous ultrasound guidance. The procedure required approximately 1 mL of 2% lidocaine without additional sedation and was completed in approximately 4 min, whereas the conventional supine strategy required multiple access points, repeated probe repositioning, minimal conscious sedation with midazolam, and approximately 20 min. At follow-up, lower-limb spasticity improved from approximately MAS 3 toward MAS 2, passive ankle angle, measured as the tibia–foot angle with 90° corresponding to the neutral ankle position, improved from approximately 80° to 95°, and semitendinosus-related hypertonia was reduced. Clinically meaningful improvement in positioning, hygiene management, assisted standing, and rehabilitation handling was observed. Caregiver-reported satisfaction and procedural tolerability were qualitatively perceived as better with the posterior single-window approach. Conclusions: The proposed posterior single-window cryoneurolysis strategy may represent a technically simplifying and clinically relevant minimally invasive approach for severe pediatric spastic equinovarus. Further prospective studies are required to confirm reproducibility, safety, and long-term outcomes. Full article

Background and Objectives: Immediately after thyroidectomy, retching driven by postoperative nausea and vomiting (PONV) may cause wound rupture, severe bleeding, and airway obstruction. Although inhaled anesthetics are widely used in thyroidectomy, they may increase the postoperative risk of PONV. Therefore, this study aimed to compare PONV incidence and recovery patterns according to the characteristics of sevoflurane (Sevo) and desflurane (Des) when remifentanil was continuously infused until extubation. Materials and Methods: This retrospective cohort study involved 70 female patients undergoing elective thyroidectomy, who were categorized into the Sevo (n = 35) and Des (n = 35) groups. Remifentanil was administered at an effect-site concentration of 2 ng/mL during emergence. Results: PONV incidence during emergence was 20% in both groups (p = 1.000). The Des group had shorter times to recovery of consciousness and extubation than the Sevo group (p < 0.001 and p < 0.001, respectively). At 5 min after extubation, patients in the Des group were more alert (p = 0.001), with 54.3% awake and responsive. Postanesthesia care unit stay was also shorter in the Des group (16.89 ± 3.22 vs. 23.74 ± 4.80; p < 0.001). Additionally, perioperative hemodynamic status, surgical site pain, and residual sedation did not differ between inhaled anesthetics. Conclusions: When remifentanil was infused until extubation after thyroidectomy, the choice of inhaled anesthetics did not affect the incidence of acute PONV. Des provided faster early recovery without additional side effects than Sevo; nonetheless, acute recovery profiles did not differ between inhaled anesthetics. Full article

Semi-synthetic cannabinoids (SSCs) are chemically modified derivatives of naturally occurring phytocannabinoids that have rapidly emerged in commercial cannabis and hemp-derived products, including vape cartridges, edibles, infused oils, and concentrated extracts. Increasing availability of compounds such as hexahydrocannabinol (HHC), HHC analogues, and Δ⁸-tetrahydrocannabinol (Δ⁸-THC) has created significant challenges for forensic toxicology, analytical detection, public health surveillance, and regulatory control. This structured narrative review evaluated current evidence on the forensic, toxicological, pharmacological, and analytical implications of SSCs. The literature published between January 2019 and May 2026 was identified through searches of PubMed, Scopus, and Web of Science using predefined search terms related to SSCs, forensic toxicology, analytical detection, intoxication, metabolism, and public health. Recent evidence demonstrates that HHC-related compounds currently dominate the SSC market and scientific literature. Available studies indicate that SSCs undergo extensive Phase I and Phase II metabolism, producing hydroxylated, oxidized, and glucuronidated metabolites that frequently predominate over parent compounds in biological matrices. This metabolic complexity complicates forensic interpretation, particularly in postmortem investigations and impairment assessments where toxicological reference ranges remain poorly established. Emerging intoxication reports describe prolonged sedation, neuropsychiatric manifestations, cognitive impairment, and severe poisoning associated with HHC analogues, although much of the current evidence remains limited to case reports and small observational studies. From an analytical perspective, conventional toxicology screening methods may fail to detect SSC exposure, necessitating advanced analytical approaches such as liquid chromatography–tandem mass spectrometry (LC–MS/MS), high-resolution mass spectrometry (HRMS), and chiral chromatographic techniques for metabolite identification and epimer differentiation. However, limited reference standards, evolving structural diversity, and regulatory variability across jurisdictions continue to hinder standardized detection and interpretation. Overall, SSCs represent a rapidly evolving class of psychoactive compounds requiring coordinated advancements in forensic toxicology, analytical surveillance, pharmacological characterization, and public health monitoring to improve detection reliability, risk assessment, and regulatory response. Full article

Background and Objectives: Elderly patients with head and neck tumours frequently present with multiple comorbidities and a potentially difficult airway, making general anaesthesia high-risk. Dexmedetomidine, a selective alpha-2 adrenoceptor agonist, provides conscious sedation without clinically significant respiratory depression, offering a compelling locoregional alternative. This study evaluated the haemodynamic profile, sedation kinetics, and satisfaction outcomes of a standardised dexmedetomidine-based protocol for head and neck surgery under local infiltration anaesthesia. Materials and Methods: A prospective, single-centre observational study was conducted at the University Hospital Centre Zagreb. Twenty-three consecutive adult patients received a continuous dexmedetomidine infusion at 0.5 μg/kg/h, initiated preoperatively in the post-anaesthesia care unit without a loading dose. Haemodynamic parameters, sedation-to-incision interval, cumulative dose, and postoperative patient and surgeon satisfaction (NRS 1–10) were recorded. Spearman rank-order correlation and the Mann–Whitney U test were used for statistical analysis. Results: The primary outcome of haemodynamic stability—defined as the absence of vasoactive or inotropic rescue—was achieved in all 23 patients (100%). The median cumulative dexmedetomidine dose was 52 μg (IQR 44–68 μg). Controlled hypotension was achieved in all patients, with a median nadir systolic blood pressure of 98 mmHg. Supplemental oxygen was required in only 2 of 23 patients (8.7%). Patient and surgeon satisfaction reached a median NRS score of 10 in both groups. The sedation-to-incision interval correlated with total drug dose (ρ = 0.74, p < 0.001), consistent with fixed-rate infusion pharmacokinetics. Hypertensive patients exhibited a greater reduction in systolic blood pressure (median 45 vs. 28 mmHg; p = 0.015). Conclusions: A fixed-rate dexmedetomidine infusion initiated in the post-anaesthesia care unit provides a feasible and potentially effective conscious sedation strategy for head and neck surgery under local infiltration anaesthesia in selected elderly and comorbid patients. In this pilot series, the protocol was associated with haemodynamic stability in all cases, low supplemental oxygen requirements, and high procedural satisfaction among both patients and surgeons. These findings are preliminary and require confirmation in larger, controlled studies. Full article

Ventilator-associated pneumonia (VAP) is linked to high mortality rates, especially in developing countries. This cross-sectional survey study was conducted across three central hospitals in the Hail region of Saudi Arabia, King Salman Specialist Hospital, Hail General Hospital, and King Khalid Hospital, to assess the knowledge and adherence of intensive care unit (ICU) healthcare practitioners to the ventilator bundle (VB) for VAP prevention. It also looked at the practitioners’ perceived barriers to effective VB deployment. The study (n = 86) revealed significant disparities in VAP prevention knowledge across educational levels regarding the recommended degree of head-of-bed (HOB) elevation (p < 0.001), the use of endotracheal tubes with extra lumens for subglottic drainage (p < 0.001), and the protective effects of 0.12% chlorhexidine gluconate antiseptic oral rinse (p = 0.019). Professional experience significantly influenced knowledge of non-standard VB components (p < 0.001), the recommended frequency of awakening and spontaneous breathing trials (SBTs) (p < 0.001), and knowledge of extra-lumen tubes (p = 0.038) and kinetic beds vs. standard beds (p = 0.005). Significant differences were found between professional categories regarding knowledge of hand hygiene performance (p = 0.032), the correct degree of HOB elevation (p = 0.007), and patient positioning (semi-recumbent vs. supine) (p = 0.023). Years of experience significantly impacted reported compliance with institutional VB (p = 0.013), adherence to oral care protocols (p = 0.035), and the assessment of sedation depth (p = 0.002). While basic measures like HOB elevation practice and DVT prophylaxis showed universal reported compliance (100%), significant performance gaps were identified in more complex tasks, such as interrupting continuous sedative infusions and performing SBTs as recommended (p < 0.001), particularly among novice practitioners. The primary implementation barrier preventing full compliance with the VB was identified as educational deficit, which was prioritized as the most important area for quality improvement, highlighting the need for targeted training for newly hired ICU staff. Full article