Neuroendoscopy is a minimally invasive surgical technique used to treat brain pathologies such as hydrocephalus, arachnoid cysts, and skull base tumors. While it offers several advantages, including reduced tissue trauma and lower morbidity, it is associated with a high risk of postoperative nausea and vomiting (PONV). This paper provides a narrative review of the literature on the incidence, pathophysiology, and management of PONV in patients undergoing neuroendoscopic procedures. The review includes several studies published between 2001 and 2024, analyzing specific risk factors such as female gender, postoperative opioid use, extended endoscopic approaches, and cavernous sinus dissection. PONV prevention strategies include a multimodal approach combining total intravenous anesthesia (TIVA) with propofol, perioperative hydration, and pharmacological prophylaxis (5-HT3 receptor antagonists, NK1 antagonists, dexamethasone, and droperidol). Despite advances in surgical and anesthetic techniques, further research is needed to develop procedure-specific protocols and optimize PONV management in neuroendoscopy.

Airway management and safety remain a difficult challenge during reconstructive surgery in patients with extensive post-burn mentosternal scar contractures. Current guidelines do not recommend the use of direct laryngoscopy for predicted difficult airway because of the risk of intubation failure and airway emergencies: the consequences of wrong decisions can be fatal, and the patient is at serious risk. At present, video-laryngoscopy is the most commonly used technique for routine orotracheal intubation. Awake tracheal intubation with fibro-bronchoscopy also remains a valid option when possible, ensuring the patient's spontaneous breathing during the procedure. However, when videolaryngoscopy is used in combination with this method, the efficiency of these devices can be increased, and a better result can be achieved. We report a case of successful management of a predicted difficult airway with combined video laryngo-bronchoscopy in an awake patient with post-burn neck scar contractures.

Severely burned patients are at high risk of local and systemic infections due to skin barrier loss. Their clinical management is complex and requires coordinated intensive care and infection prevention strategies. Diagnosing infective endocarditis (IE) in this population is particularly difficult due to overlapping symptoms and limited diagnostic specificity. Common pathogens include Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii. We conducted a retrospective cohort study on 543 patients with burns affecting >18% of total body surface area (TBSA), admitted to our Burn Intensive Care Unit (BICU) from 2019 to 2024. The incidence of infective endocarditis was 1.47%, involving aortic (75%), mitral (12.5%), and tricuspid (12.5%) valves. Pathogens identified included S. aureus, Klebsiella pneumoniae, A. baumannii, and P. aeruginosa. This incidence is significantly higher than that in the general population. Mortality reached 50%, with an overall 3-month mortality of 75%. The literature on IE in burn patients is scarce, and the role of antibiotic prophylaxis remains controversial. Infective endocarditis in burn patients, although rare, represents a severe complication with high mortality. Early diagnosis and coordinated multidisciplinary care are essential to improve patient outcomes.

Background: Pain management in patients with severe burns remains one of the most complex challenges in perioperative care. Burn-related pain is multifactorial, resulting from tissue destruction, intense inflammation, surgical procedures, and repeated dressing changes. Opioids remain the cornerstone of analgesia; however, prolonged use is associated with tolerance, dependence, adverse effects, and prolonged hospitalization. Multimodal and opioid-sparing strategies, including regional anesthesia, may improve postoperative outcomes by enhancing analgesia while reducing systemic drug exposure. This study aimed to evaluate the effectiveness of a standardized regional anesthesia protocol in reducing postoperative pain and opioid requirements in burn patients undergoing lower-limb escharectomy and autologous skin grafting. Methods: We conducted a retrospective, single-center analysis of 25 adult patients with deep thermal burns of the lower limbs who underwent escharectomy and split-thickness skin grafting. All patients received a combined ultrasound-guided sciatic popliteal block and adductor canal block on both the burned limb and the donor site. Ropivacaine 0.375% with clonidine was administered without exceeding a total dose of 3.0 mg/kg. Postoperative pain was assessed using the Numerical Rating Scale (NRS), and opioid consumption was recorded as rescue doses in intravenous morphine equivalents. Secondary outcomes included perioperative complications and 30-day hospital readmission. Results: Regional anesthesia provided effective postoperative pain control. Thirty-two percent of patients reported no pain (NRS 0), 52% reported mild pain (NRS 1–3), and 16% reported moderate pain (NRS 4–6). No patient reported severe pain (NRS 7–10). Only four patients (16%) required rescue opioids. No perioperative complications or block-related adverse events occurred, and no patient required hospital readmission within 30 days. Conclusions: In this cohort, regional anesthesia was associated with satisfactory postoperative analgesia and minimal opioid requirements. By reducing opioid exposure, this approach may help improve patient comfort and potentially limit opioid-related adverse effects. Larger prospective studies are needed to confirm these findings and to assess long-term outcomes.