This case report describes the use of a lidocaine-ketamine-propofol total intravenous anesthesia (TIVA) protocol in two chinchillas (Chinchilla lanigera). Two 4-year-old, 0.60 and 0.63 kg, intact female chinchillas underwent general anesthesia for dentistry. The first chinchilla presented for occlusal adjustment, but mucopurulent vaginal discharge was identified following sedation. Diagnostic findings were most consistent with an open pyometra, and an exploratory laparotomy with ovariohysterectomy was performed. Histopathology confirmed uterine adenocarcinoma. The second chinchilla underwent intraoral extraction of the right mandibular fourth cheek tooth because of advanced periodontal disease. Both chinchillas were premedicated with buprenorphine, dexmedetomidine, midazolam, and ketamine, followed by intravenous induction of anesthesia with an initial popofol bolus (0.5 mg kg[-1]), lidocaine (2 mg kg[-1]), ketamine (1.6 mg kg[-1]), and additional propofol titrated to effect (1.5 and 0 mg kg[-1] for chinchillas 1 and 2, respectively). Chinchilla 1 was administered one additional intravenous propofol bolus (0.5 mg kg[-1]) during ovarian pedicle manipulation. Anesthesia was maintained with TIVA, using constant rate infusions of lidocaine (100 μg kg[-1] minute[-1]), ketamine (0.6 mg kg[-1] hour[-1]), and propofol [1.6 mg kg[-1] hour[-1] (chinchilla 1) and 2.0 mg kg[-1] hour[-1] (chinchilla 2)]. Orotracheal intubation was achieved in both chinchillas using a 2.0 mm uncuffed endotracheal tube. Both chinchillas maintained spontaneous ventilation, although decreased respiratory rates, mild hypercapnia, and intraoperative hypothermia occurred. Recovery was uneventful in both cases. These cases suggest that this anesthetic protocol may provide satisfactory anesthesia for both short- and intermediate-duration procedures in chinchillas; however, further investigation is warranted to evaluate its safety and efficacy in a larger population. A review of the literature indicates this is the first report describing lidocaine-ketamine-propofol TIVA in chinchillas and the first report of uterine adenocarcinoma in this species.

Suicide is one of the leading causes of death among adolescents in the United States. The 'Acute Course of Ketamine Versus Midazolam for Recurrence of Suicidality in Adolescents' (TASK), a double-blind, randomized, controlled trial, was designed to examine the signal for efficacy of ketamine, compared to midazolam (active control), in reducing 1) repeat suicidal events, 2) implicit cognition, and 3) depression symptoms and suicidal thoughts and behaviors in adolescents (ages 13-18 years) with recent suicidal events. The report describes the study rationale and design, and the baseline cohort characteristics. Participants were randomized (1:1) to receive either intravenous ketamine (0.5 mg/kg) or midazolam (0.02 mg/kg) for four infusions during the first two weeks (days 0, 3, 7, 10). Participants completed follow-up assessment visits weekly through week 12 (twice weekly during the first two weeks) to monitor outcomes. Of the 70 participants who consented/assented to screening, 55 were deemed eligible, and 50 were randomized to ketamine or midazolam. The participants were 82% female and 64% White, with a mean age of 15.4 years (SD = 1.6). On average, the adolescents had three lifetime suicide attempts (SD = 2), two inpatient hospitalizations for lifetime suicidal ideation (SD = 2), and one lifetime emergency evaluation for suicidal ideation (SD = 1). Approximately three out of four youth (74%) reported moderate to severe depression, and 54% reported moderate to severe anxiety. TASK study findings may inform the use of ketamine to reduce suicidal events in youths with recent suicidal events. Clinical Trial Registration: The trial is registered with ClinicalTrials.gov (NCT04592809; date of registration - 10.19.2020).

This clinical practice update provides evidence-based recommendations on the use of remimazolam, a novel ultra-short-acting benzodiazepine, for procedural sedation during GI endoscopy. Remimazolam was approved by the Food and Drug Administration in July 2020 for use in procedural sedation. It offers rapid onset, short duration of action, and organ-independent metabolism, making it an alternative to traditional sedatives such as midazolam and propofol. This update synthesizes data from randomized controlled trials, meta-analyses, and real-world studies, addressing efficacy, safety, dosing, and patient selection. It aims to assist clinicians in optimizing sedation while minimizing risks, particularly in high-risk populations. Previous guidelines, such as the 2018 American Society for Gastrointestinal Endoscopy guidelines on sedation and anesthesia in GI endoscopy, focused on midazolam and propofol but did not include remimazolam. This update incorporates emerging evidence to guide the integration of remimazolam into practice.

Background Sedative medication is routinely used during colonoscopy. Sedation practices may vary in terms of the type and dose of administered medication, possibly impacting clinical outcomes, associated risks, and financial and environmental burdens. We aimed to assess trends and variations in colonoscopy sedation in the Netherlands. Methods Data prospectively recorded in the Dutch Gastrointestinal Endoscopy Audit registry between January 2020 and January 2025 were analyzed. Annual trends in the application of different types of sedation were assessed. Variations across endoscopy units were evaluated by comparing midazolam dosing regimens and the proportional application of propofol-based sedation. Regression analyses assessing the association between sedation and cecal intubation and polyp detection were performed. Results Data from 285,241 colonoscopies were included. Application of propofol-based sedation increased from 5.8% (2020) to 10.0% (2024). The largest increases were observed for IBD-related (11.6-23.2%) and therapeutic indications (28.2-51.7%). For midazolam-based sedation, the mean dose administered varied considerably across units (2.1-5.6mg), as did the proportional application of propofol-based sedation (median 5.0% [IQR 2.3-15.7]; range 0-38%). Compared to midazolam-based sedation using doses equal to or lower than 2.5 mg, propofol-based sedation was not associated with improved cecal intubation (-0.7%; 95% confidence interval [CI] -1.0 to -0.3%), although it was associated with polyp detection (+5.5%; 95% CI +2.8 to +8.3%). Conclusion Colonoscopy sedation practices vary across Dutch endoscopy units in terms of midazolam dosing regimens and the proportional application of propofol-based sedation. In general, propofol-based colonoscopy sedation is increasing. This study's findings may inform guidelines for more standardized, evidence-based, and resource-conscious sedation practices.

Aims The aim of this study was to identify which dental providers, registered with the Care Quality Commission (CQC), provide conscious sedation, establishing what techniques they employ, which patient groups they treat, while beginning to determine the level of risk associated with sedation provision through assessment of compliance during inspection.Methods Firstly, a short, three-question, Checkbox survey was distributed to dental providers, registered with CQC, via email. Secondly, CQC inspection reports, for all dental providers found not to meet regulations, were thematically analysed for non-compliance. The results were analysed using Microsoft Excel.Results In total, 8,536 survey responses were received resulting in a response rate of 81.3%. Results confirmed 20.6% of dental providers offer a conscious sedation service with most (89.6%) using the benzodiazepine midazolam and treating adult patients (63.7%). Just over 5% of dental practices deliver advanced sedation techniques and 37.8% use a peripatetic (visiting) sedationist. Between September 2021 and August 2025, 2,906 dental providers were inspected with 488 practices failing to meet one or more regulations, with 69 delivering sedation. Common aspects of non-compliance included lack of evidence of sedation and/or life support training and inadequate patient monitoring.Conclusions Demand for conscious sedation in dentistry is high, with over one-fifth of dental providers offering the service. In the main, most services deliver standard techniques, using midazolam only, nitrous oxide and treating adult and paediatric patients, respectively. Nevertheless, providers outlined a range of offerings. On the whole, sedation provision in dental practice is delivered safely in compliance with national standards. There are, however, aspects that increase the risk of adverse outcomes and it is therefore essential practitioners familiarise themselves with relevant guidelines and standards and align their practise with such.

Grapefruit juice (GFJ) evokes food-drug interactions (FDIs) via mechanism-based inhibition (MBI) of gastrointestinal cytochrome P450 (CYP) 3A4. Bergamottin (BG) and 6',7'-dihydroxybergamottin (DHB) are the primary constituents responsible for this inhibition. Although CYP3A4 and CYP3A5 share overlapping substrate specificity, their inhibitor sensitivity can differ. While BG is a known mechanism-based inhibitor of CYP3A5, the inhibitory property of DHB on the CYP3A5 remains uncharacterized. This study aimed to characterize the inhibitory kinetics of DHB and BG on CYP3A5 metabolic activity in vitro.