Prophylactic esketamine given before or during surgery reduces postoperative depressive symptoms and the incidence of depression, anxiety, and chronic pain, while improving sleep quality and overall quality of life. A meta-analysis of 11 randomized controlled trials involving 1447 participants found that esketamine lowered depressive symptoms (standardized mean difference -0.61) and cut the risk of postoperative depression by 63% (relative risk 0.37). The evidence suggests that using esketamine preventively during the perioperative period offers significant benefits for patients' mental health and recovery.
In children undergoing tonsillectomy and adenoidectomy, adding esketamine during anesthesia reduced postoperative pain and emergence agitation without increasing side effects. Eighty children were randomly assigned to receive esketamine or a control. Pain scores (FLACC scale) were lower in the esketamine group at all measured times from 15 minutes to 24 hours after surgery (e.g., 2.4 vs. 3.4 at 15 minutes). Emergence agitation scores were also lower. Blood markers of inflammation (C-reactive protein and interleukin-6) rose less in the esketamine group. Recovery times and adverse reactions were similar between groups.