In this article, we conduct a systematic review of the literature to explore the specific role of dexmedetomidine (DEX) on postoperative sleep and its associated mechanisms at present. The electronic database Embase, MEDLINE/PubMed, the Cochrane Library, Web of Science, and Google Scholar were searched. The restriction terms included “dexmedetomidine”, “sleep” and “surgery”. The inclusion criteria were as following: 1) patients 18 years old or older; 2) DEX used in the perioperative period not just for critically ill patients in the intensive care unit (ICU); 3) prospective or retrospective studies. The review articles, conference abstracts, and animal studies were excluded. Out of the 22 articles which met the above criteria, 20 of them were randomized controlled studies and 2 of them were retrospective cohort studies. Infusion of DEX including during the surgery and after surgery at a low or high dose was shown to improve subjective and objective sleep quality, although 2 studies showed there is no evidence that the use of DEX improves sleep quality and 1 showed less sleep efficiency and shorter total sleep time in the DEX group. Other postoperative outcomes evaluated postoperative nausea and vomiting, pain, postoperative delirium bradycardia and hypotension. Outcomes of our systematic review showed that DEX has advantages in improving patients’ postoperative sleep quality. Combined with the use of general anesthetic, DEX provides a reliable choice for procedural sedation.

Purpose: Propofol and sufentanil are the most commonly used anesthetics during bronchoscopy. Esketamine is an s-enantiomer of ketamine racemate and has both sedative and analgesic effects, it does not inhibit respiration and maintains hemodynamic stability. We aimed to compare the intraoperative hypoxemia risk of esketamine/propofol with sufentanil/propofol for patients in bronchoscopy. Methods: This study was an investigator-initiated, single-center, randomized, double-blind clinical trial. Patients undergoing bronchoscopy were randomly assigned to receive either sufentanil group (n = 33; sufentanil: 0.2 μg/kg) or esketamine group (n = 33; esketamine: 0.2 mg/kg) for sedation and analgesia. Clinical data, anesthetics usage, incidence of intraoperative hypoxemia, total time of hypoxemia, recovery time, and adverse events were recorded. Main Results: The incidence of intraoperative hypoxemia was significantly lower in the esketamine group than in the sufentanil group (27.2% vs 66.7%, P=0.001, OR=5.333, 95% CI=1.859– 15.301). Propofol usage was significantly higher in the esketamine group than in the sufentanil group (t=2.952, P=0.004). The duration of hypoxia was significantly lower in the esketamine group than in the sufentanil group (Z=− 3.445, P< 0.001), and the minimum oxygen saturation (SpO2) was significantly higher than in the sufentanil group (Z=− 2.682, P=0.007). Recovery time from anesthesia was significantly lower in the esketamine group than in the sufentanil group (Z=− 2.709, P=0.007). No difference was found in adverse reactions between the two groups. Conclusion: Esketamine combined with propofol reduced the incidence of intraoperative hypoxemia compared with sufentanil in bronchoscopy. Our results offer the possibility for a novel recommendation for the prevention of intraoperative hypoxemia during bronchoscopy. However, we mentioned the higher propofol use in the esketamine group. Additional clarification is necessary on the indications and the optimal dose of esketamine. Trial Registration: Chinese clinical trial registry: ChiCTR2200058990.

Objectives: Postoperative cognitive dysfunction is a debilitating postoperative complication. The perioperative neuroprotective effect of lidocaine has conflicting results.Methods: In this qualitative review of randomized controlled clinical trials on the perioperative use of lidocaine, we report the effects of intravenous lidocaine on brain function after noncardiac surgery. Studies were identified from PubMed, MEDLINE, and Cochrane Central Register.Results: Of the 453 retrieved studies, 4 randomized trials were included. No significant association between the use of lidocaine postoperative cognitive states was found (risk ratio 0.67; 95% CI −0.02 to 1.36; I²89%; p = .06).Conclusions: Current evidence cannot suggest that perioperative intravenous use of lidocaine has pharmacological brain neuroprotection after noncardiac surgery. All the included studies were small‐scale research, and the total number of participants was small; the results should be interpreted with caution.

People with schizophrenia are more likely to be afflicted by obesity or overweight compared to the general population. This study aimed to explore the incidence of overweight and obesity, clinical features and cognitive performance of Chinese Han patients with chronic schizophrenia who had overweight or obesity. We obtained data from 985 schizophrenia inpatients about overweight and obesity through body mass index (BMI). All patients were evaluated with the positive and negative syndrome scale, the Mini-mental State Examination (MMSE) and the repeated battery for evaluation of the neuropsychological status (RBANS) scale. We collected demographic and clinical data using self-reported questionnaires. We divided patients into normal weight (BMI < 24 kg/m²), overweight (24 ≤ BMI < 28 kg/m²) and obese (≥28 kg/m²) groups according to the Working Group on Obesity in China (WGOC) criteria. We compared the clinical data between the three groups and then conducted binary logistic regression and linear regression to assess variables that were significantly associated with overweight and obesity and higher BMI. Of the sample, 324 (32.9%) and 191 (19.4%) patients had overweight and obesity, respectively. Patients who had overweight and obesity were younger, had less education, had higher waist and hip circumferences, higher rates of diabetes and a higher sumPANSP score (compared with patients in the normal group, p < 0.05). There were more female patients with obesity (compared with patients in the normal and overweight groups, p < 0.05). Logistic regression analysis indicated that overweight and obesity were associated with sumPANSP (OR = 1.03, 95%CI = 1–1.061, p = 0.049) and diabetes (OR = 1.891, 95%CI = 1.255–2.849, p = 0.002). Further linear regression showed that age (B = −0.004, t = −2.83, p = 0.005), educational level (B = −0.037, t = −2.261, p = 0.024), diabetes (B = 0.133, t = 2.721, p = 0.007) and sumPANSP (B = 0.008, t = 2.552, p = 0.011) were risk factors for higher BMI. We did not find cognitive performance differences between patients with or without overweight and obesity. Overweight and obesity were associated with some demographic and clinical factors in patients with persistent schizophrenia.

Background and Objectives: Growing evidence suggested that abnormal lipid metabolism (ALM) was associated with an increased severity of depressive symptoms, but no previous studies have examined the differences in comorbid ALM in major depressive disorder (MDD) patients of different ages of onset. We aim to compare the differences in the prevalence and clinical correlates of ALM between early-onset and late-onset patients with first-episode and drug-naive (FEDN) MDD patients. Methods: Using a cross-sectional design, we recruited a total of 1718 FEDN MDD outpatients in this study. We used the 17-item Hamilton Rating Scale for Depression (HAMD-17), The Hamilton Anxiety Rating Scale (HAMA), the Positive and Negative Syndrome Scale (PANSS) positive subscale, and Clinical Global Impression-Severity Scale (CGI-S) to assess their depression, anxiety, and psychotic symptoms and clinical severity, respectively. Results: There were 349 patients (20.3%) in the early-onset subgroup and 1369 (79.7%) in the late-onset subgroup. In this study, 65.1% (1188/1718) of patients were diagnosed with ALM. The prevalence of ALM in the late-onset group (81.5%, 1116/1369) was significantly higher than that in the early-onset group (20.6%, 72/349) (p = 0.36, OR = 1.147, 95%CI = 0.855–1.537). The HAMD total score (OR = 1.34, 95% CI = 1.18–1.53, p < 0.001) was the only risk factor for ALM in early-onset MDD patients. In late-onset MDD patients, the HAMD total score (OR = 1.19, 95% CI = 1.11–1.28, p < 0.001), TSH (OR = 1.25, 95% CI = 1.16–1.36, p < 0.001), CGI (OR = 1.7, 95% CI = 1.31–2.19, p < 0.001), and anxiety (OR = 2.22, 95% CI = 1.23–4.02, p = 0.008) were risk factors for ALM. Conclusion and Scientific Significance: Our results suggest that there are significant differences in the prevalence and clinical factors of comorbid ALM between early-onset and late-onset FEND MDD patients.

BackgroundTo investigate the difference of demographic, health status and clinical characteristics of patients with or without insomnia postoperatively, and to identify the potential risk factors of insomnia.Methods299 patients undergoing surgery were included. Patients were divided into group A (insomnia, N = 78) and group B (without insomnia, N = 221). Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Montreal cognitive assessment (MoCA) were applied to all patients preoperatively. Visual Analogue Scale (VAS) was assessed preoperatively, and at the end of the surgery, one day after surgery, two days after surgery and three days after surgery. The PHQ-9, the GAD-7 and the ISI were reassessed three days after surgery. Information on sociodemographic variables and demographic data were collected.ResultsAmong the two groups, the average points patients got in the ISI, PHQ-9 and the GAD-7 in group A were also significantly higher than those in group B. The VAS score 3 days after surgery was significantly higher in group A. The PHQ-9 and the GAD-7 3 days after surgery showed significantly higher depression and anxiety scores in group A. Logistic regression showed ISI (P < 0.001, 95%CI = 1.218-1.500), the GAD-7 (P = 0.01, 95%CI = 0.712–0.954) preoperatively and the PHQ-9 postoperatively (P < 0.001, 95%CI = 1.226–1.555) were risk factors of insomnia.ConclusionsInsomnia is common in patients, which worsen after surgery. The present study suggests that depression and anxiety are risk factors of poor sleep quality after surgery. There is a need for further research and strategies for depression and anxiety management to achieve better sleep and significant health benefits in these patients.Trial registration: clinical trial, NCT04027751. Registered 22 July 2019, https://clinicaltrials.gov/ct2/show/NCT04027751?cond=NCT04027751&cntry=CN&draw=2&rank=1.