Aims Recurrence of secondary hyperparathyroidism (SHPT) remains a big challenge in uremic patients who underwent total parathyroidectomy with auto-transplantation (tPTX-AT). However, the relationship between perioperative intervention and recurrence of SHPT remains unclear. Dexmedetomidine has been used safely and effectively in uremic patients’ anesthesia. The aim of the study was to explore the effect of dexmedetomidine on the recurrence of SHPT and speculate the possible mechanism of action. Methods Records of patients who underwent tPTX-AT between 2017 and 2018 were retrospectively analyzed. The study consisted of patients who received dexmedetomidine intra-operatively and the controls were patients who did not receive dexmedetomidine. The primary endpoint was the difference in the recurrence of SHPT one year after surgery between the two groups. The secondary endpoint was health-related quality of life scores. Analysis included propensity score matching and multivariable logistic regression. Results Of 354 patients, 133 had received dexmedetomidine intraoperatively, and the total recurrence rate of SHPT was 10.2%. After propensity score matching, patients who received dexmedetomidine had a 3.80-fold decreased risk of SHPT recurrence (odds ratio, 0.263; 95% confidence interval, 0.081 to 0.854; P=0.026) and exhibited a better quality of life in terms of physical functioning and general health, and less emotional role limitations compared with those in control group. Conclusion In uremic patients who received tPTX-AT, there was an association between dexmedetomidine use and decreased risk of SHPT recurrence. However, further studies are needed to accurately assess the effects and mechanism of action of dexmedetomidine on the prognosis of this population.

Aim: Thyroidectomy is frequently associated with substantial postoperative pain. Esketamine, an N-methyl-D-aspartate receptor antagonist, has been demonstrated to be effective in multiple analgesia. We hypothesized that intraoperative administration of esketamine may reduce perioperative opioid consumption and postoperative pain in patients undergoing thyroidectomy. Methods: Sixty patients undergoing thyroidectomy were randomly assigned to two groups. Patients in the saline group received a pre-incisional intravenous bolus of 0.9% NaCl followed by an intraoperative infusion of 0.9% NaCl; patients in the esketamine group received a pre-incisional intravenous bolus of esketamine (0.5 mg kg-1) followed by an intraoperative infusion of esketamine (0.24 mg kg-1 h-1). The primary outcome was perioperative sufentanil consumption. The postoperative pain, sleep quality, and adverse events during the first postoperative 24 h were also evaluated. Results: Patients in the esketamine group consumed significantly less sufentanil than those in the saline group (24.6 ± 3.1 μg vs. 33.7 ± 5.1 μg, mean difference, 9.1; 95% confidence interval, 6.9–11.3, P <0.001). Postoperative pain scores were significantly lower in the esketamine group than those in the saline group during the first 24 h postoperatively (P <0.05). Patients receiving esketamine experienced higher sleep quality than those in the saline group during surgical night (P = 0.043). There were no significant differences in adverse events between the two groups. Conclusion: Intraoperative administration of esketamine reduces perioperative sufentanil consumption and postoperative pain without increasing adverse events in patients undergoing thyroidectomy. The development of combined anesthesia regimens, including esketamine, may foster strategies for pain management during thyroidectomy.