Benzodiazepines are the recommended first-line treatment for canine seizure emergencies, and non-parenteral routes are essential when intravenous access is unavailable. Clinical trials show that intranasal midazolam controls emergency seizures more reliably than rectal diazepam, yet the cortical electrophysiological correlates of these routes remain uncharacterised in dogs. In a two-session, fixed-order (non-randomised) study, the quantitative electroencephalographic (qEEG) profiles of intranasal midazolam (IN-MDZ; 0.2 mg/kg), volume-matched intranasal saline (IN-SAL) and intrarectal diazepam (IR-DZP; 0.5 mg/kg) were compared in six healthy adult dogs. Propofol (1%, 0.5 mL/kg IV) was given in both sessions for electrode placement, and recording followed clinical recovery. Metrics were computed at baseline and 1, 3 and 5 min and analysed with the dog as the unit of replication (n = 6), using Friedman and exact Wilcoxon tests with false-discovery-rate (FDR) control. IN-MDZ was associated with a coherent, rapidly emerging cortical-slowing signature: at 1-3 min it separated from both controls across relative delta, beta, delta/beta, theta/alpha, alpha and entropy, unanimously and drug-specifically, the correlated indices reflecting a single coherent spectral shift reproduced at two time points. This slowing, in contrast to the beta activation reported in seizing human patients, is consistent with a genuine, rapidly acting GABAergic effect, and is concordant with the established clinical efficacy of intranasal midazolam. No contrast survived false-discovery-rate correction; the core indices nonetheless persisted on baseline-corrected change scores (r = 0.7-0.9). The study defines the qEEG endpoints, effect sizes and sample size required for an adequately powered confirmatory trial.

Opioids and benzodiazepines provide the foundation for procedural sedation during wound care following burn injury. Ketamine has been used as an adjunct and may limit exposure to opioids. Few data are published describing the use of oral ketamine in this population. This study was performed to compare the effects of oral ketamine on opioid and benzodiazepine requirements during wound care following burn injury. This was a retrospective, single center cohort study (August 2022-2024). The electronic medical record was queried for adult (≥18 years) patients admitted to the burn intensive care unit who received oral ketamine as a premedication for wound care. The primary outcome was oral morphine equivalents (OMEs) before (pre) and after (post) initiation of oral ketamine. Only medications used during wound care were recorded. Descriptive statistics were utilized for analysis. A total of 52 patients were included. The median percent total body surface area (%TBSA) burned was 31 (IQR 20-48). The median ketamine dose received during wound care was 100 mg (IQR 100-125). All patients received IV fentanyl and 47 (90%) received IV midazolam. Patients received a median of 225 mg (IQR 150-300) vs 180 mg (IQR 120-240) (P=0.008) of OMEs in the pre- and post-groups, respectively. There was no difference in midazolam received (6 mg [IQR 4-8] vs 5 mg [IQR 3-8]; P = 0.21). Oral ketamine may be an effective adjunct to wound care following burn injury and may reduce exposure to opioids.

A 13-year-old intact male mixed-breed dog with a left-sided adrenal gland mass presented for an anesthetized computed tomography scan to aid with surgical planning. The dog had previously undergone transvenous implantation of a single-chamber, right-sided permanent pacemaker placed for treatment of a high-grade second-degree atrioventricular block. The pacemaker mode was changed from variable rate response (ventricular pacing, ventricular sensing, inhibited response, and rate modulation) to fixed demand (ventricular pacing, ventricular sensing, and inhibited response) in preparation for anesthesia, and the rate was set to 95 beats minute[-1]. The dog was premedicated with intravenous (IV) butorphanol tartrate (0.3 mg kg[-1]) and anesthesia was induced with propofol (1.25 mg kg[-1], IV) and midazolam (0.3 mg kg[-1], IV). Anesthesia was maintained with isoflurane delivered in oxygen. Following induction of anesthesia, there was a decrease in the mean arterial blood pressure from 108 mmHg to 45 mmHg, which was effectively treated with a bolus of lactated Ringer's solution (5 mL kg[-1], IV) and infusions of dopamine (12 μg kg[-1] minute[-1]) and norepinephrine (0.1 μg kg[-1] minute[-1]). After starting dopamine and norepinephrine infusions, mean arterial blood pressure increased to 80 mmHg, and the ventricular rate decreased to 60 beats minute[-1]. Interrogation of the pacemaker revealed a change in T-wave morphology, which resulted in T-wave oversensing. Decreasing the lead sensitivity of the pacemaker corrected oversensing and restored the paced ventricular rate to 95 beats minute[-1].

Catatonia is a neuropsychiatric syndrome characterized by disturbances in motor activity, affect, and autonomic function. Although often associated with primary mood or psychotic disorders, it can be precipitated or sustained by systemic infections such as urinary tract infection (UTI). We describe a 60-year-old man with recurrent catatonia and diagnoses of schizophrenia, bipolar disorder, and major neurocognitive disorder, whose latest episode of catatonia, described in this case report, was preceded by psychosocial stress and appeared to be exacerbated by polymicrobial UTI, bacteremia, and urosepsis. He had a history of neuroleptic malignant syndrome (NMS) and an inconsistent response to electroconvulsive therapy (ECT), limiting usual first-line treatment options. During this admission, he developed Klebsiella pneumoniae UTI with Staphylococcus simulans bacteremia and later Pseudomonas aeruginosa urosepsis, in the context of mixed central and nephrogenic diabetes insipidus likely related to long-term lithium therapy. The patient's catatonia proved refractory to very high-dose lorazepam but improved with an intensive, multimodal regimen including intravenous (IV) benzodiazepines (diazepam, midazolam), enteral and subsequently oral lorazepam, zolpidem, memantine, and aggressive treatment of infection and electrolyte abnormalities. He ultimately regained baseline function and was discharged on a slow taper of benzodiazepines and zolpidem. This case illustrates the bidirectional relationship between infection, autonomic and immune dysregulation, and catatonia; highlights practical challenges when treatment with benzodiazepines and ECT is constrained by medical comorbidity; and supports considering adjunctive GABAergic and glutamatergic agents in carefully selected cases of refractory catatonia, under close specialist supervision.

Total parenteral nutrition (TPN) is a nutritional therapy in children when oral or enteral feeding is not possible, fails to meet nutritional requirements or is contraindicated due to underlying clinical conditions. There are many cases where children who are given one or more than one intravenous medication also need TPN. In order to minimise vein access, these medications are commonly administered via a Y-site IV connection where they admix with TPN, implying a need for compatibility studies before admixing the medication into the nutritional fluid. In this study, previously developed and validated HPTLC methods were verified for their suitability to evaluate the concentrations of three commonly used medications in neonatal intensive care units (NICUs), namely caffeine citrate, ibuprofen arginine, and midazolam hydrochloride. Silica gel 60 F254 HPTLC plates were used as the stationary phase, and acetone: toluene: chloroform (4:3:3, v/v/v), toluene: methanol: ethyl acetate: glacial acetic acid (5.5:3.2:1:0.3, v/v/v/v), and cyclohexane: toluene: diethylamine (7:1.5:1.5, v/v/v) with one drop of 25% ammonia solution were used as mobile phases. The compatibility of the three drugs in their respective TPN admixtures was then assessed at various time points over a 24 h period using these HPTLC methods. Each drug admixed in TPN was directly applied onto the HPTLC plates without further sample pre-treatment. Paired Two-One-Sided Test (TOST) equivalent testing revealed that the concentrations of the selected drugs in TPN were unchanged over the monitoring period (p > 0.05), confirming chemical compatibility. These findings were in line with previous studies that concluded compatibility and reported similar RF and LOD/LOQ values (1.95/5.90 ng/band for caffeine, 252.22/764.30 ng/band for ibuprofen and 10.82/32.78 ng/band for midazolam; R[2] ≥ 0.99). As no additional sample pre-treatment was required, HPTLC-based compatibility studies of drug-TPN admixtures may simplify the analytical workflow, making them a cost-effective and time-efficient approach to compatibility testing.

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.