Clinical Report: The Impact of Esketamine on Postoperative Emotional Distress

Overview

This systematic review and meta-analysis evaluates the effects of esketamine on postoperative anxiety, depression, and cognitive function in patients undergoing general anesthesia. Findings indicate significant reductions in depressive and anxiety symptoms, while cognitive outcomes remain unclear due to high heterogeneity and low evidence certainty.

Background

Postoperative neuropsychiatric complications, including anxiety and depression, significantly affect surgical outcomes and recovery. With an aging population and increasing surgical procedures, addressing these complications is crucial. Esketamine, a novel treatment with rapid antidepressant properties, may offer a new approach to managing postoperative emotional distress.

Data Highlights

Key Findings

• Esketamine significantly reduced depressive symptoms (SMD = -0.92).
• Esketamine significantly reduced anxiety symptoms (SMD = -1.23).
• Cognitive outcomes showed high heterogeneity; MMSE results were significant after excluding an outlier.
• MoCA results remained non-significant with very low evidence certainty.
• The overall certainty of evidence for cognitive effects was rated very low.

Clinical Implications

The findings suggest that esketamine may be effective in reducing postoperative anxiety and depression, which are critical for recovery. However, the unclear cognitive benefits highlight the need for further research to establish its role in perioperative care.

Conclusion

Esketamine shows promise in managing postoperative emotional distress, but further high-quality studies are necessary to clarify its cognitive effects and optimal dosing.

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