Clinical Scorecard: Impact of Low-Dose Esketamine on Anxiety and Depression in Post-Surgical Breast Cancer Patients: A Double-Blind, Randomized Controlled Trial

At a Glance

Key Highlights

• Esketamine administered at subanesthetic doses (0.2 mg/kg induction, 0.1 mg/kg/h infusion) during surgery
• Primary outcome: sustained reduction in depressive symptoms measured by PHQ-9 at postoperative day 30
• Secondary outcomes: anxiety reduction (SAS scores) and pain control (NRS) with monitoring of adverse events

Guideline-Based Recommendations

Diagnosis

• Use validated scales such as PHQ-9 for depression and SAS for anxiety preoperatively and postoperatively
• Assess baseline psychological status prior to surgery

Management

• Consider perioperative administration of low-dose esketamine to reduce postoperative anxiety and depression
• Administer esketamine at 0.2 mg/kg during induction followed by 0.1 mg/kg/h infusion until surgery end
• Maintain standard anesthesia protocols alongside esketamine administration

Monitoring & Follow-up

• Monitor PHQ-9 and SAS scores at baseline, postoperative day 7, and day 30 to evaluate treatment effect
• Assess pain using Numeric Rating Scale at rest on postoperative day 1
• Observe for adverse events within 24 hours post-surgery

Risks

• Contraindications include refractory hypertension, severe cardiovascular dysfunction, hyperthyroidism, and anesthesia-related contraindications
• Monitor for potential adverse events related to esketamine within the first 24 postoperative hours

Patient & Prescribing Data

120 breast cancer patients aged 18-70 years undergoing surgery

Esketamine showed potential for rapid and sustained reduction in depressive and anxiety symptoms with analgesic benefits and acceptable safety profile

Clinical Best Practices

• Ensure informed consent and screen for contraindications prior to esketamine administration
• Implement double-blind, randomized controlled protocols to minimize bias
• Use validated Chinese versions of PHQ-9 and SAS for psychological assessment
• Maintain hemodynamic stability and standard anesthesia monitoring during esketamine infusion
• Follow up patients through at least 30 days postoperatively to assess sustained psychological outcomes

References

• Breast cancer prevalence and psychological impact
• PHQ-9 validation in Chinese populations
• SAS scale validation and use
• Esketamine pharmacology and antidepressant effects