Progress in the Application of Esketamine During the Perioperative Period

Esketamine is the S-enantiomer of ketamine. As a potent NMDA receptor antagonist with high affinity, it exhibits sedative, analgesic, and antidepressant properties, among others. Compared with racemic ketamine, esketamine demonstrates approximately twice the potency, along with several advantages: a rapid onset of action, mild respiratory depression, and fewer adverse psychiatric effects. In recent years, the perioperative application of esketamine has garnered increasing attention. It has demonstrated potential application value in clinical practice, particularly in obstetric anesthesia, pediatric surgical anesthesia, orthopedic surgical anesthesia, painless diagnostic and therapeutic procedures, and special clinical scenarios. The pharmacological mechanism of esketamine has not been fully elucidated to date, and research on its perioperative application remains relatively limited. High quality evidence from large-sample, multicenter studies is scarce, and no unified standard has been established for its administration regimens and dosages. Nonetheless, this paper provides a summary of the pharmacological properties, potential mechanisms of action, and current clinical applications of esketamine across diverse clinical scenarios, with the overarching goal of providing evidence to support its rational use in clinical practice.