Palliation of various single ventricle congenital cardiac lesions, such as tricuspid atresia and hypoplastic left heart syndrome, involves procedures that direct the flow of systemic venous blood return directly into the pulmonary arteries (cavo-pulmonary connections), clas- sically known as the Fontan procedure. This circulatory pattern is unique as there is no ventricle to actively pump blood through the lungs. Effective functioning of the novel circuit requires unobstructed flow, maintenance of preload, adequate contractile function of the single ven- tricle, and a low-normal pulmonary vascular resistance. These components allow unimpeded flow of blood through the pulmonary circulation to the left side of the circulation. Preservation of spontaneous ventilation is advantageous because negative intrathoracic pressure during inspiration supports systemic venous return and passive pulmonary blood flow. We present a 12-year-old adolescent with Fontan physiology who required proce- dural sedation for placement of a hemodialysis catheter in the interventional radiology suite. Procedural sedation during IR procedures is discussed, benefits of spontane- ous ventilation in Fontan physiology reviewed, and use of remimazolam as the primary agent in these scenarios presented.
Impacted maxillary canines are among the most frequent eruption disorders in adolescents. Standard management – surgical exposure followed by orthodontic traction – is commonly performed under general anesthesia or deep sedation, so non-invasive adjuncts capable of promoting eruption without an operative procedure are of interest beyond orthodontics. A trans-mucosal low-frequency ul- trasound protocol intended to stimulate delayed eruption of permanent teeth was previously developed and exper- imentally investigated by our research group; clinical ev- idence supporting its effectiveness remains limited. Methods We report on the management of a 14-year-11-month-old girl with bilaterally impacted maxillary canines, Class II Division 2 malocclusion and deep overbite. Diagnosis was based on clinical examination, panoramic radiog- raphy, lateral cephalometry and cone-beam computed to- mography. Treatment comprised rapid maxillary expan- sion and fixed appliance therapy. Trans-mucosal low-fre- quency ultrasound (26.5 kHz, 1 W/cm2, amplitude 40–60 μm) was applied to the mucosa overlying the left impacted canine (tooth 23) according to the previously developed protocol, in ten sessions of 5 s. Results The right maxillary canine (tooth 13) erupted spontane- ously without adjunctive intervention. After the ultra- sound course, the crown of tooth 23 emerged clinically; an orthodontic attachment was then bonded and traction initiated. Both canines were aligned into a functional Class I occlusion with satisfactory esthetic and occlusal outcomes. Conclusions Clinical emergence of the ultrasound-treated canine fol- lowed the adjunctive intervention; causality cannot be es- tablished from a single case because of concurrent ortho- dontic treatment and the absence of interval radiographic assessment. Standardized low-frequency ultrasound pro- tocols warrant evaluation in controlled clinical studies as a potential non-surgical, anesthesia-sparing option in ad- olescents.
ntroduction Mortality in neonatal anaesthesia is low in high-income countries (<5%), but high in Africa. The studies on this topic are scarce. This study aimed to identify predictors of mortality in neonatal anaesthesia in Kinshasa. Methods A prospective cohort study conducted among 178 new- borns who underwent anaesthesia for a surgical and/or diagnostic procedure in five hospitals. Recruitment was exhaustive and consecutive. Pre, intraoperative and post- operative evolutionary variables, were recorded. Statisti- cal analyses used Chi-square test, bivariate and multivar- iate logistic regression; the threshold for statistical signif- icance was set at p < 0.05. Results Post-anaesthesia mortality was 39.9%. Significant pre- dictors were: prematurity (ORa = 4.9), birth weight ( ORa = 3.5), weight on the day of surgery < 2500 g ( ORa = 3.9), age on the day of surgery between 1–7 days (ORa = 5.7) and 8–14 days ( ORa = 9.8), American Society of Anesthesiologists (ASA)-physical status III ( ORa = 10.2; p = 0.001) and IV ( ORa = 18.7; p = 0.001), and emergency ( ORa = 3.05). General anaesthesia was pre- dominant (96.6%) and associated with mortality (p = 0.005). Standard monitoring was absent in 100% of cases. Conclusion Post-anaesthesia neonatal mortality in Kinshasa remains high. The specific predictors identified serve as a warning sign in clinical management to reduce this mortality.
Cardiac surgery is frequently associated with significant perioperative morbidity resulting from hemodynamic instability, postoperative atrial fibrillation (POAF), acute kidney injury (AKI), systemic inflammatory response, postoperative delirium (POD), and prolonged intensive care unit (ICU) stay. Dexmedetomidine, a highly selective alpha 2-adrenergic receptor agonist, has emerged as an important adjunct in contemporary cardiac anesthesia and critical care because of its unique combination of sedative, sympatholytic, analgesic-sparing, anti-inflammatory, and organ-protective properties. The purpose of this review is to summarize current evidence regarding the use of dexmedetomidine in adult and pediatric cardiac surgery. Recent randomized controlled trials, systematic reviews, and meta-analyses demonstrate that dexmedetomidine contributes to improved perioperative hemodynamic stability through attenuation of sympathetic activation, reduction of circulating catecholamines, and preservation of myocardial oxygen balance. These effects appear to reduce the incidence of postoperative atrial fibrillation and improve cardiovascular recovery following cardiac surgery. In addition to its cardiovascular benefits, dexmedetomidine has demonstrated significant neuroprotective potential. Contemporary evidence supports its role in reducing postoperative delirium, particularly among elderly patients undergoing procedures involving cardiopulmonary bypass. Furthermore, emerging data suggest favorable effects on postoperative cognitive recovery through anti-inflammatory, antioxidant, and sleep-preserving mechanisms. Dexmedetomidine also exhibits clinically relevant cardioprotective, renoprotective, and anti-inflammatory effects. Experimental and clinical studies have shown reductions in myocardial injury biomarkers, inflammatory cytokine release, and the incidence of acute kidney injury following cardiac surgery. In pediatric patients undergoing surgery for congenital heart disease, dexmedetomidine has been associated with improved hemodynamic stability, reduced opioid requirements, effective postoperative sedation, and decreased incidence of junctional ectopic tachycardia. Current evidence supports dexmedetomidine as a valuable component of modern perioperative cardiac care. However, further large-scale multicenter randomized trials are needed to establish optimal dosing strategies and identify patient populations most likely to benefit from dexmedetomidine-based protocols.
Pain is defined as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." To be classified as chronic pain, the condition must per- sist for more than three months. Its management requires a multimodal and multidisciplinary approach, in which hyperbaric oxygen therapy (HBOT), although still a sub- ject of debate, represents a promising therapeutic oppor- tunity. There are multiple biological and biochemical mecha- nisms through which hyperbaric oxygen acts in the treat- ment of various pain syndromes.
Introduction To describe anesthetic management and early perioperative outcomes in infants and young children undergoing repair of congenital diaphragmatic hernia or diaphragmatic eventration at a tertiary center, with an exploratory analysis of patients who received propofol for induction. Materials and Methods We retrospectively reviewed 21 children who underwent repair under general anesthesia. Demographic characteristics, comorbidities, anesthetic technique, serial mean arterial pressure (MAP), vasoactive drug use, intraoperative complications, and early postoperative outcomes were collected. Propofol-exposed hernia and eventration subgroups were compared exploratorily. Results Fourteen children had hernia and seven had eventration. Conventional two-lung ventilation was used in 20/21 cases. In the propofol-exposed subgroup (n=14), median propofol dose was similar in hernia and eventration patients (6.0 [4.5-6.0] vs 5.0 [5.0-6.0] mg/kg; p=0.895). Absolute MAP decline from baseline was also similar. No bradycardia occurred; one hypotension episode was recorded. Conclusion In this single-center cohort, diaphragmatic repair was usually managed with intravenous induction, volatile maintenance, and two-lung ventilation. In selected propofol-exposed patients, no clear signal of major immediate propofol-related instability was observed. Larger multicenter studies are needed.
Introduction Preoperative anxiety is a common and clinically significant problem in pediatric anesthesia. Oral midazolam has traditionally been used for premedication, however, it is associated with variable efficacy and potential adverse effects. Inhalational dexmedetomidine is increasingly being considered as a safer and promising alternative for pediatric premedication. The aim of this study was to compare the efficacy and safety of inhalational dexmedetomidine and oral midazolam in terms of sedation quality, hemodynamic and respiratory stability, as well as the child's cooperation during premedication. Methods This prospective randomized study included 60 children aged 2-12 years, ASA physical status I-II, undergoing abdominal or urological surgical procedures. The participants were divided into two groups: the dexmedetomidine group (group D) received inhalational dexmedetomidine at a dose of 2 & micro;g/kg, while the midazolam group (group M) received oral midazolam at a dose of 0.3 mg/kg. Vital parameters and sedation levels were monitored 10, 20, and 30 minutes after drug administration. Cooperation was assessed during intravenous cannulation, separation from parents, and acceptance of the anesthesia mask during induction of general anesthesia. Results After 10 minutes, a statistically significant difference in sedation level was observed in favor of group M (p = 0.003). After 20 and 30 minutes, no statistically significant differences between the groups were observed (p > 0.05). During intravenous cannulation, no statistically significant difference was found (p = 0.061), although a clear trend favored group D. Successful separation from parents was comparable between groups (p > 0.05), whereas mask acceptance was more effective in group M (83.3%) compared with group D (53.3%; p = 0.033). Hemodynamic parameters remained stable, with transient bradycardia observed only in group D. No significant respiratory adverse effects were recorded. Conclusion Inhalational dexmedetomidine demonstrated comparable efficacy to oral midazolam with a favorable safety profile, making it a suitable alternative for premedication in pediatric anesthesia.
Background: Spinal anaesthesia in paediatric patients has experienced a resurgence driven by concerns regarding anaesthetic neurotoxicity and evidence demonstrating safety and efficacy. However, its application in medically complex children with multiple comorbidities remains underreported. Clinical case: We report an 11-year-old female with a his- tory of posterior fossa medulloblastoma treated with sur- gical resection, chemotherapy, and craniospinal radio- therapy at age of 2, followed by disease relapse at age of 4 requiring cervical spine surgery (C1-C5 laminectomy with fixation), high-dose chemotherapy, autologous bone marrow transplantation, and radiotherapy. She presented with bilateral proximal femoral epiphysiolysis requiring in situ fixation. Anaesthetic challenges included severe cervical spine restriction with complete inability to ex- tend the neck, limited mouth opening creating a predicted difficult airway, subglottic tracheal stenosis immediately below the vocal cords further complicating airway man- agement, and a radiation-exposed brain vulnerable to ad- ditional anaesthetic neurotoxicity. After preoperative MRI evaluation confirming no contraindications at the lumbar level, single-shot spinal anaesthesia was per- formed at L3-L4 with 6 mg of 0.5% isobaric bupivacaine plus 5 mcg fentanyl, complemented by light sedation with ketamine and propofol. The procedure was com- pleted uneventfully in 50 minutes. The patient recovered rapidly with minimal motor blockade at 90 minutes, was hemodynamically stable, comfortable, and pain-free. Discussion: This case illustrates three key advantages of spinal anaesthesia in this complex patient: (1) complete avoidance of airway instrumentation in a predicted diffi- cult airway scenario compounded by subglottic stenosis, (2) minimization of cerebral anaesthetic exposure in a pa- tient with radiation-induced brain vulnerability, and (3) demonstrated safety of neuraxial techniques in patients with prior cervical spine surgery when the lumbar spine is unaffected. The bilateral presentation of slipped capital femoral epiphysis is consistent with the 211-fold in- creased risk documented in paediatric cancer survivors receiving growth hormone therapy after total body irradi- ation. Conclusion: Spinal anaesthesia can be safely and suc- cessfully performed in medically complex paediatric pa- tients when applied with appropriate patient selection, thorough preoperative evaluation including spinal imag- ing, multidisciplinary collaboration, and meticulous tech- nique. This case supports broader consideration of spinal anaesthesia in paediatric patients with difficult airways, prior neurotoxic exposures, or conditions where general anaesthesia poses elevated risks.
ntroduction Preoperative anxiety is a common and clinically signifi- cant problem in pediatric anesthesia. Oral midazolam has traditionally been used for premedication, however, it is associated with variable efficacy and potential adverse effects. Inhalational dexmedetomidine is increasingly be- ing considered as a safer and promising alternative for pediatric premedication. The aim of this study was to compare the efficacy and safety of inhalational dexme- detomidine and oral midazolam in terms of sedation qual- ity, hemodynamic and respiratory stability, as well as the child’s cooperation during premedication. Methods This prospective randomized study included 60 children aged 2–12 years, ASA physical status I–II, undergoing abdominal or urological surgical procedures. The partic- ipants were divided into two groups: the dexmedetomi- dine group (group D) received inhalational dexme- detomidine at a dose of 2 μg/kg, while the midazolam group (group M) received oral midazolam at a dose of 0.3 mg/kg. Vital parameters and sedation levels were moni- tored 10, 20, and 30 minutes after drug administration. Cooperation was assessed during intravenous Sad, Faculty of Medicine, Novi Sad, Serbia. cannulation, separation from parents, and acceptance of the anesthesia mask during induction of general anesthe- sia. Results After 10 minutes, a statistically significant difference in sedation level was observed in favor of group M (p = 0.003). After 20 and 30 minutes, no statistically signifi- cant differences between the groups were observed (p > 0.05). During intravenous cannulation, no statistically significant difference was found (p = 0.061), although a clear trend favored group D. Successful separation from parents was comparable between groups (p > 0.05), whereas mask acceptance was more effective in group M (83.3%) compared with group D (53.3%; p = 0.033). He- modynamic parameters remained stable, with transient bradycardia observed only in group D. No significant res- piratory adverse effects were recorded. Conclusion Inhalational dexmedetomidine demonstrated comparable efficacy to oral midazolam with a favorable safety pro- file, making it a suitable alternative for premedication in pediatric anesthesia.
The clinical impact , outcomes of poisoning can vary markedly according to the substance involved. Identifying the causative toxic agent(s) in a patient is fun- damental to optimal clinical management. Clinical presentation may differ with the agent, dose, du- ration of exposure , pre-existing comorbidities. In a peripheral hospital, adequate planning and organisa- tion of care pathways, together with appropriate procure- ment and stockholdings of antidotes, are essential for ef- fective clinical management.
Introduction Juvenile temporomandibular joint (TMJ) osteoarthritis is a progressive inflammatory-degenerative disorder associated with chronic pain, functional limitation, and reduced quality of life in adolescents. Chondroprotective therapy may provide structural and anti-inflammatory benefits. This study evaluated the efficacy and safety of glucosamine-chondroitin combination (Teraflex) in the complex treatment of juvenile TMJ osteoarthritis. Materials and Methods A prospective clinical study included 61 adolescents (aged 16-18 years) diagnosed with juvenile TMJ osteoarthritis. Clinical parameters included pain intensity, mandibular mobility, joint crepitation, physician and patient functional assessment, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and polymorphonuclear elastase levels measured using ELISA. Teraflex (500 mg glucosamine hydrochloride + 400 mg chondroitin sulfate) was administered twice daily for 3 months as part of multimodal therapy. Results After 3 months, clinical improvement was observed in 94% of patients. Interincisal distance increased significantly, mandibular mobility improved, and joint noises resolved in 79% of cases. Elastase activity demonstrated a statistically significant decrease (p < 0.05). ESR and CRP levels approached normal ranges. No serious adverse effects were recorded. Conclusions Glucosamine-chondroitin combination therapy appears to be a safe and effective adjunct in the management of juvenile TMJ osteoarthritis, contributing to functional recovery and reduction of inflammatory activity.
Stroke in children is a rare but potentially devastating condition, with long-term functional, cognitive, and psychosocial consequences. Adult functional prognostic scores, including the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS), are extensively utilized to forecast outcomes post-stroke; however, their relevance in pediatric populations is still ambiguous. Pediatric stroke differs from adult stroke in etiology, including sickle cell disease, congenital heart defects, arteriopathies, and infections, and recovery trajectories are influenced by neurodevelopmental plasticity. Resource-limited settings further complicate prognostication due to constrained access to neuroimaging, rehabilitation, and specialized care. This perspective examines the limitations of applying adult functional prognostic scores to children, highlighting risks of misclassification and bias. We propose the development of hybrid, pediatric-adapted prognostic tools that integrate clinical, developmental, and contextual determinants of recovery. Artificial intelligence (AI) presents significant prospects for improving prediction accuracy by integrating multidimensional data and simulating outcomes under diverse resource constraints. We emphasize ethical considerations, such as the equitable allocation of scarce resources and parental engagement. Developing validated, context-sensitive pediatric stroke prognostic scores could improve individualized care, optimize resource utilization, and support long-term functional recovery in children, particularly in low-resource environments.
Stroke in low-income countries poses special problems, particularly in intensive care units (ICUs), where both pe- diatric and adult survivors exhibit distinct clinical pheno- types. Pediatric stroke is often associated with sickle cell disease, congenital heart defects, and infections, while adults predominantly present with hypertension-driven ischemic and hemorrhagic strokes. Resource con- straints—including limited access to neuroimaging, thrombolysis, and specialized stroke units—exacerbate delays in diagnosis and management, contributing to higher morbidity and mortality. Emerging preventive strategies, such as transcranial Doppler screening and hy- droxyurea therapy in children with sickle cell disease, demonstrate significant potential in reducing stroke inci- dence and improving neurocognitive outcomes. A com- parative analysis of pediatric and adult stroke phenotypes highlights the necessity for age-specific ICU protocols, contextually tailored management, and capacity-building initiatives in resource-limited environmentsThis mini-re- view highlights critical differences in etiology, presenta- tion, and prognosis and provides perspectives for future research and intervention strategies aimed at improving stroke care across age groups in resource-limited envi- ronments.
Pediatric poisonings represent a significant global health issue, with important implications for children’s well-be- ing and healthcare resources. Toxic agents include drugs, household products, plants and substances of abuse, with exposure occurring mainly via the oral route. Early child- hood is at major risk for accidental exposure, while inten- tional poisonings prevail in adolescents. Clinical man- agement requires immediate stabilization, accurate his- tory taking, targeted laboratory evaluation and timely use of antidotes. Prevention, through caregiver education and home safety, remains essential.
Introduction Critical congenital heart disease in neonates and infants requires urgent intervention and is associated with significant perioperative instability. Catheter-based procedures are increasingly used as alternatives to open surgery; however, anesthetic management strategies remain insufficiently characterized. This study aimed to evaluate anesthesia and critical care approaches during transcatheter interventions in early childhood. Materials and Methods Neonates and infants undergoing endovascular correction of critical congenital heart defects were included. Clinical assessment, instrumental diagnostics, and hemodynamic monitoring were applied. Anesthesia consisted of combined sedation using ketamine and local anesthesia with anticoagulation using heparin. Hemodynamic stability, ventilatory requirements, and early complications were assessed. Results Anesthetic management maintained stable hemodynamics in most patients. No major anesthesia-related complications were observed. Procedures were well tolerated and required minimal respiratory support. Conclusion Optimized anesthesia strategies enable safe endovascular interventions in neonates and infants with critical congenital heart disease. These findings highlight the essential role of pediatric anesthesiology in improving perioperative outcomes. Keywords Anesthetic management, Critical congenital heart disease, Neonatal endovascular intervention Introduction Critical congenital heart disease (CCHD) represents a heterogeneous group of structural cardiac and great vessel anomalies arising during embryogenesis that lead to severe hemodynamic compromise shortly after birth. Congenital heart defects account for nearly one-third of major congenital anomalies and constitute a leading cause of neonatal morbidity and mortality worldwide. Their prevalence is estimated at approximately 4-10 cases per 1,000 live births, with a substantial proportion requiring intervention during the first year of life. Globally, congenital heart disease affects approximately 0.8-1% of newborns annually, corresponding to tens of
Children with heart failure increasingly present for non- cardiac procedures, yet they remain at high risk for peri- operative morbidity and mortality. Traditional lesion-fo- cused anesthetic approaches fail to capture the physio- logic vulnerability that drives adverse outcomes. This perspective synthesizes current evidence on perioperative risk, emphasizing physiology-based determinants—ven- tricular dysfunction, pulmonary hypertension, cyanosis, and recent decompensation—as stronger predictors than anatomic diagnosis alone. It highlights the critical role of preoperative optimization, multidisciplinary planning, and intraoperative strategies tailored to fragile cardiovas- cular physiology. Postoperative vigilance, extended mon- itoring, and system-level interventions are essential, par- ticularly in low-resource settings where structural inequi- ties exacerbate risk. By integrating a physiology-driven, equity-focused approach, anesthesiologists can anticipate instability, reduce preventable complications, and im- prove survival for this vulnerable population worldwide.
We report the anesthetic management of a 27-day-old, 500-gram female infant (birth weight 580g), born at 246/7 weeks gestation, undergoing Ommaya reservoir place- ment for progressive posthemorrhagic hydrocephalus. It underscores the multidisciplinary perioperative chal- lenges inherent in caring for extremely low birth weight (ELBW) infants with significant comorbidities, including cardiorespiratory compromise and evolving grade III in- traventricular hemorrhage (IVH). Critical anesthetic strategies included: strict, milliliter-precise fluid re- striction; ventilation management using the existing mo- bile ventilator in synchronized intermittent mandatory ventilation with volume guarantee (SIMV-VG) mode, maintaining permissive hypercapnia; pharmacologic mi- crodosing with microgram-range opioids and muscle re- laxants; and continuous hemodynamic support via ti- trated inotrope infusion. The infant tolerated the 20-mi- nute procedure without hemodynamic instability, respir- atory deterioration, or exacerbation of metabolic acido- sis. This case demonstrates the feasibility of neurosurgi- cal interventions in infants at the extreme lower limit of viability (500 grams) when supported by precision anesthesia techniques tailored to extreme physiological immaturity.
Antimicrobial resistance (AMR) represents a major threat to global health, with critically ill patients in intensive care units (ICUs) particularly vulnerable. In Kinshasa, Democratic Republic of Congo, both pediatric and adult ICUs face a high prevalence of multidrug-resistant pathogens, including Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, extended-spectrum beta-lactamase (ESBL)-producing, and carbapenem-resistant strains. Limited laboratory capacity, weak antimicrobial stewardship, widespread empirical antibiotic use, and suboptimal infection control exacerbate the problem, contributing to prolonged hospital stays, higher morbidity and mortality, and increased healthcare costs. Innovative approaches are urgently needed to improve detection, management, and prevention of resistant infections in resource-limited settings. Artificial intelligence (AI) offers a transformative solution by integrating clinical, microbiological, and environmental data to predict resistant infections, guide individualized therapy, detect outbreaks in real time, and support stewardship Mayemba et al. AI andAMR in Kinshasa ICUs programs. Evidence from pediatric ICUs shows reductions in inappropriate antibiotic use and improved clinical outcomes, while predictive models in adult ICUs can anticipate sepsis and early mortality. Successful implementation in Kinshasa requires adaptation to local epidemiology, staff training, high-quality data systems, and integration into existing workflows. Combining AI with robust antimicrobial stewardship and infection control measures could enhance patient care, optimize antibiotic use, and inform public health strategies, offering a sustainable approach to mitigating AMR in critically ill populations in low-resource environments.
Introduction Airway management is a critical skill in intensive care, as tracheal intubation carries significant risks. Optimizing safety and first-pass success is essential in both adults and children. In resource-limited settings, equipment constraints and training gaps further complicate this management, highlighting the need for standardized, evidence-based approaches. Objectives: This systematic review aimed to synthesize existing international guidelines on airway management in critically ill adults and children, identify differences between populations, challenges in resource-limited settings, and evidence-based strategies to optimize safety and first-pass success. Methods A systematic search was conducted in PubMed, Embase, the Cochrane Library, and national and international guideline databases up to January 2025. Guidelines published since 2010, concerning adult or pediatric populations and including pharmacological and/or non-pharmacological recommendations, were eligible. Two reviewers independently selected studies, extracted data, and assessed methodological quality using the AGREE II tool. Recommendations were compared according to population, type of intervention, and level of evidence, and results were synthesized qualitatively. Results Among 1,482 references, 42 guidelines were included: 18 for adults, 12 for children, and 12 for resource-limited settings. The main recommendations for adults included optimized preoxygenation, bougie-assisted intubation, and systematic preparation to reduce complications. Pediatric guidelines emphasized anatomical and physiological adaptations, the use of videolaryngoscopy, and trained teams. In resource-limited settings, priority was given to simplified bundles, standardized protocols, and targeted training. The certainty of evidence was high for adults, moderate for pediatric recommendations, and variable for resource-limited settings. Conclusion Despite universal principles, their implementation must take into account patient age, physiological differences, and resource availability. Standardized protocols, appropriate use of airway management tools, and dedicated team training are essential to reduce complications and improve first-pass success. This review provides clinicians and policymakers with practical guidelines for safe and effective airway management in various critical care settings.
Fibromyalgia is characterized by chronic, widespread musculoskeletal pain and is often associated with asthenia, sleep disturbances, cognitive difficulties (e.g., impaired attention and memory), psychiatric comorbidities (e.g., anxiety and depression), and a wide range of somatic and neurovegetative symptoms. The use of a clinical diary, preferably completed on a daily basis, allows for a more objective and systematic collection of data related to pain symptomatology. Relying solely on verbal anamnesis may be substantially biased by the patient's psychological and emotional state at the time of assessment, as well as by limitations in recall.
