Ropivacaine, a widely used regional anesthetic also used for pain management, has been increasingly used in recent years due to its increased efficacy and improved safety compared to similar anesthetics. Biomonitoring of ropivacaine and its metabolites during and after anesthesia is an essential process for ensuring therapeutic efficacy and safe usage for patients. The most useful biomonitoring tool in recent years has been liquid chromatography coupled with mass spectrometry (LC-MS/MS), which offers selectivity, sensitivity, as well as accuracy of measurements. The current manuscript summarizes and discusses the existing liquid chromatographic methods described in the literature, as well as the personal experience with developing bioanalytical and analytical methods for the quantification of ropivacaine in biological samples for clinical applications. It is focused on methodological aspects, recent advancements, challenges, and future perspectives, highlighting the importance of LC-MS/MS techniques in ropivacaine analysis.

Melatonin, an indoleamine crucial for regulating circadian rhythms, sleep–wake cycles, and immune–endocrine homeostasis, is present in biological fluids at extremely low concentrations, making its quantification analytically challenging. This narrative review provides a critical comparative assessment of current methodologies for melatonin determination across various biological matrices—plasma, urine, saliva, breast milk, and hair. The discussed techniques include immunoassays, colorimetric and spectrophotometric methods, chromatographic–mass spectrometric platforms (LC–MS/MS, UHPLC–MS/MS), and emerging biosensors. Each approach is evaluated regarding analytical sensitivity, specificity, reproducibility, cost, and clinical applicability. While immunoenzymatic and colorimetric techniques offer accessible, low-cost solutions for large-scale or preliminary studies, LC–MS/MS remains the benchmark for reference analysis, providing sub-picogram detection limits and multiplexing capability. However, its high cost, procedural complexity, and inter-laboratory variability limit routine implementation. New developments, including molecularly imprinted polymers, dispersive microextraction, and nanomaterial-based biosensors, suggest a shift toward hybrid, sustainable, and portable analytical platforms. By synthesizing recent methodological advances and identifying key limitations, this review aims to guide researchers and clinicians in selecting the most appropriate analytical approach for clinical, pharmacological, and circadian biomonitoring applications.

Background and Objectives: Implantation of cardiac implantable electronic devices (CIEDs) is increasingly performed in elderly and comorbid patients, for whom minimizing perioperative complications—including pain and systemic drug use—is critical. Traditional local infiltration often provides insufficient analgesia. The ultrasound-guided PECS II block, an interfascial regional technique, offers promising analgesic benefits in thoracic wall procedures but remains underutilized in cardiac electrophysiology. Materials and Methods: We conducted a prospective, controlled, non-randomized clinical study including 106 patients undergoing de novo CIED implantation. Patients were assigned to receive either a PECS II block (n = 53) or standard lidocaine-based local anesthesia (n = 53). Pain intensity was assessed using the numeric rating scale (NRS) intraoperatively and at 1, 6, and 12 h postoperatively. Secondary outcomes included the need for rescue analgesia, procedural duration, length of hospitalization, and patient satisfaction. Results: Patients in the PECS II group reported significantly lower NRS scores at all time points (mean intraoperative score: 2.1 ± 1.2 vs. 5.7 ± 1.6, p < 0.001; at 1 h: 2.5 ± 1.5 vs. 6.1 ± 1.7, p < 0.001). Rescue analgesia (metamizole sodium) was required in only four PECS II patients (7.5%) vs. 100% in the control group within 1 h. Hospital stay and procedural time were also modestly reduced in the PECS II group. Patient satisfaction scores were significantly higher in the intervention group. Conclusions: The ultrasound-guided PECS II block significantly reduces perioperative pain and the need for additional analgesia during CIED implantation, offering an effective, safe, and opioid-sparing alternative to conventional local infiltration. Its integration into clinical protocols for device implantation may enhance procedural comfort and recovery.

Regional anesthesia techniques such as the ultrasound-guided PECS II (pectoral nerve block) block are increasingly employed to optimize perioperative analgesia while minimizing systemic anesthetic exposure. Ropivacaine is commonly used for its favorable pharmacological profile; however, clinical data on its pharmacokinetics and systemic metabolite behavior following interpectoral administration remain limited. This study aimed to characterize the plasma concentration–time profile of ropivacaine and its main active metabolite, 3-OH-ropivacaine, in patients undergoing interpectoral nerve block, using a validated LC-MS/MS (liquid chromatography coupled with mass spectrometry) method. Venous blood samples were collected from 18 patients at predefined time points (0, 1, 3, 6, and 24 h) following a PECS II block performed with a ropivacaine-lidocaine mixture. Plasma concentrations were quantified via a validated LC-MS/MS protocol in accordance with FDA (Food and Drug Administration) and EMA (European Medicines Agency) guidelines. Pharmacokinetic parameters were derived using non-compartmental analysis. Ropivacaine reached a mean peak plasma concentration (Cmax—maximum concentration) of 167.5 ± 28.3 ng/mL at 1.3 ± 0.2 h (Tmax—maximum time). The metabolite 3-OH-ropivacaine peaked at 124.1 ± 21.4 ng/mL at 2.3 ± 0.3 h. The terminal elimination half-life was 19.4 ± 2.8 h for ropivacaine and 29.2 ± 3.1 h for its metabolite. Plasma levels demonstrated prolonged systemic exposure with predictable pharmacokinetics. The PECS II block using ropivacaine results in sustained systemic levels of both the parent drug and its primary metabolite, supporting its role in prolonged perioperative analgesia. These data provide a pharmacokinetic foundation for personalized regional anesthesia protocols. This strategy facilitates the adaptation of anesthetic protocols to the individual characteristics of each patient, aligning with the principles of personalized medicine, particularly in patients with altered metabolic capacity.

During pregnancy and in the postpartum period, several diseases may arise or become exacerbated. Acute pancreatitis incidence during pregnancy is similar to the general population but increases in the first two years after delivery. This case report describes the evolution of necrotizing acute pancreatitis in a 30-year-old woman five months postpartum, with an atypical debut of acute pancreatitis, where the high levels of triglycerides caused by hormonal changes in the late postpartum period overlapped with an underlying hyperlipemia. Despite aggressive, multidisciplinary care, including surgical necrosectomy, continuous renal replacement therapy (CRRT), protective ventilation, and venovenous extracorporeal membrane oxygenation (VV-ECMO), the prognosis was influenced by the hormonal changes both secondary to hypothalamic–pituitary–adrenal dysregulation and the postpartum hormonal changes, leading to an altered inflammatory response, evolution to MODS, ultimately resulting in death. The case highlights the complex interplay between postpartum immune and hormonal changes and the systemic inflammatory response of pancreatitis, emphasizing the critical need for postpartum-specific guidelines in managing acute pancreatitis, particularly regarding early risk stratification in order to prevent this pathology and its complications.

Contemporary intensive care is operating in an environment with high complexity cases, large volumes of information, and vast physiological, biological and therapeutical data, collected from laboratory results, investigations, therapies for organ support, collected from systems that operate in parallel. The lack of interoperability contributes to infor-mation overload, alarm fatigue, and delayed decision-making. The Smart ICU concept has emerged to address these limitations by integrating medical devices, information systems and artificial intelligence into a unified system that allows interoperable data integration and predictive analytics. Aim: The purpose of this article is to provide a narrative review of the Smart ICU concept, with a specific focus on the cardiac intensive care unit. It summarizes Smart ICU architec-ture, data integration, clinical support and applicability in monitoring perioperative in-flammation in cardiac surgery. We describe the Smart ICU architecture, from data acquisition to storage and analytics, highlighting the difference between Smart ICU, Artificial Intelligence and Tele-ICU, and we underlie the predictive analytics as a supportive tool, and its influence on clinical out-come. Cardiac ICU application: Cardiac ICUs offer a data-dense, temporally well-defined model following cardiac surgery with cardiopulmonary bypass, where data concerning patients hemodynamics, perfusion data, biological and inflammatory markers intertwine. Cardiac Smart ICU models could recognize early signs of hemodynamic compromise and low car-diac output states and identify early indicators of post-cardiac surgery complications. Neutrophil activation and complete blood count–derived indices may be used as dy-namic biological data for Smart Cardiac ICU models. Conclusion: The Smart Cardiac ICU may support earlier risk stratification, therefore earlier diagnostic and therapeutic interventions, but its clinical value requires prospective, mul-ticentre validation. Cardiopulmonary bypass–induced inflammation may offer an ideal setting to integrate physiological, procedural, and immunological data into bedside pre-dictive models.