Postoperative sleep disturbance (PSD) is a common complication hindering recovery. Esketamine, an S (+)-enantiomer of ketamine, has shown potential in improving sleep and mood, but its specific efficacy in preventing PSD remains to be quantitatively synthesized. This study aims to evaluate the efficacy and safety of perioperative esketamine in preventing PSD and reducing its incidence in adult surgical patients using meta-analysis and trial sequential analysis (TSA). We searched PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to August 20, 2026, for RCTs comparing perioperative esketamine with a normal saline placebo control regarding the incidence of PSD in patients undergoing various surgical procedures. Primary outcomes were PSD incidence on postoperative days (POD) 1 and 3. Secondary outcomes included sleep, anxiety, depression, and pain scores, as well as intraoperative remifentanil consumption, quality of recovery and adverse events. TSA was conducted to verify the conclusiveness of the evidence. A total of 15 RCTs involving 1,863 patients were included. Esketamine significantly reduced the incidence of PSD on POD1 and POD3. TSA confirmed these primary outcomes as conclusive. It also significantly decreased the incidence of PSD on POD7 although TSA indicated that the current evidence for this late time point remains inconclusive due to limited sample size. Furthermore, esketamine significantly improved subjective sleep quality and overall quality of recovery, while alleviating pain, reducing early anxiety, and decreasing intraoperative remifentanil consumption. However, these therapeutic benefits did not extend to postoperative depression scores. Subgroup analyses revealed consistent efficacy across elderly (≥ 60 years) and non-elderly patients. Continuous intraoperative infusion and other administration routes demonstrated comparable protective effects, and sub-anesthetic infusion rates below 0.5 mg/kg/h were sufficient to achieve clinical benefits. No significant differences were found regarding the incidence of adverse events between groups. Perioperative esketamine safely and effectively reduces the incidence of PSD. Low dose administration including continuous infusion below 0.5 mg/kg/h serves as an effective preventive option demonstrating consistent efficacy across both elderly patients aged 60 years or older and younger populations. CRD420251250904.
Critical care in low- and middle-income countries (LMICs) like Pakistan, particularly in remote areas, is constrained by limited infrastructure and expertise. Telemedicine can bridge this gap by connecting frontline ICU physicians with remote critical care experts. While tele-ICU models have been evaluated in high-income settings, limited evidence exists from LMICs. This study evaluated the acceptability, feasibility, and utilization of a peer-to-peer tele-ICU consultation service launched by Aga Khan University in Pakistan. We conducted a cross-sectional mixed-methods study using 145 survey responses and 10 in-depth interviews of physicians who had utilized a national Tele-ICU consultation service. Quantitative data were collected using a structured survey. Qualitative data were obtained through open-ended survey responses and 10 in-depth interviews. Survey data were analyzed using descriptive statistics while qualitative data underwent thematic analysis by two independent reviewers to identify key themes related to service use, quality, and feasibility. Of 219 physicians, 145 (66.2
This study aimed to evaluate the validity, reliability, and acceptability of the Turkish version of the pediatric anesthesia patient satisfaction questionnaire by Iacobucci et al. This prospective validation study involved 203 pediatric patients aged 1–16 undergoing elective surgery and their parents. The questionnaire was translated into Turkish using forward-backward translation. Data were collected postoperatively through structured interviews. Reliability was assessed with Cronbach’s alpha and test-retest analysis. Validity evaluations included CVI, EFA, CFA, and known-group validity. 75.9
Managing fear and uncooperative behavior in pediatric dentistry is challenging. The present study re-analyzed data from a randomized 2 × 2 crossover clinical trial to evaluate whether reducing ketamine dose in an intranasal midazolam–ketamine regimen altered crying and oxygen saturation in young children undergoing dental treatment. Twenty children aged 3–6 years who completed both periods of the original crossover trial received two intranasal sedative combinations across two treatment sessions: midazolam/ketamine 0.4/4 mg·kg⁻¹ and 0.5/3 mg·kg⁻¹. Crying and peripheral oxygen saturation (SpO₂) were measured at baseline, 10 minutes, and 20 minutes. A Bayesian joint modeling approach was used to assess the association between the two longitudinal outcomes. SpO₂ remained within the recorded normal clinical range in both regimens, while crying decreased over time. The estimated association between crying and SpO₂ was weak and negative. No clear evidence of a difference between regimens was observed for either outcome. Within the limits of this small crossover dataset, reducing ketamine from 4 to 3 mg·kg⁻¹ in combination with intranasal midazolam did not materially change the recorded crying or SpO₂ outcomes. Crying was analyzed as a binary outcome, which may not fully capture behavioral control or sedation adequacy. These findings should be interpreted cautiously because this study represents a secondary Bayesian re-analysis of a previously conducted clinical trial.
Ciprofol (HSK3486) is a novel gamma-aminobutyric acid type A (GABAA) receptor agonist that provides anesthetic efficacy comparable to propofol. This study compared the postoperative recovery quality of ciprofol versus propofol in patients who underwent laparoscopic surgery under general anesthesia. In this prospective, single-center, randomized, parallel controlled study (ChiCTR2400085402), patients who were scheduled for elective laparoscopic surgery under general anesthesia were recruited. Patients were randomly assigned in a 1:1 ratio to receive ciprofol or propofol for anesthesia induction and maintenance. The primary endpoint was the restlessness score (RS) after awakening. Between August 9, 2024, and September 29, 2025, 94 patients were randomly assigned to receive ciprofol (n = 47) or propofol (n = 47). Patients in the ciprofol group exhibited significantly lower mean RS after awakening (0.17 ± 0.38 vs. 0.48 ± 0.62, P = 0.005), with a higher proportion of patients achieving an RS after awakening of 0 (83.0
