Clinical applications of esketamine: Current status and future perspectives

Ketamine, a dissociative anesthetic, has been extensively used in clinical anesthesia and sedation. However, its use in general anesthesia is gradually declining because of numerous adverse effects. In 2019, esketamine was introduced to the Chinese market. This narrative review aimed to summarize the current status of clinical applications and research progress of esketamine and to explore its future prospects in clinical practice. The scope of this review covered the pharmacological properties of esketamine; its clinical applications in surgical anesthesia, perioperative analgesia, painless diagnosis and treatment, intensive care, emergency care, and special populations (pediatric and obstetric patients); and its organ-protective effects and application value in the treatment of mental disorders. In addition, the adverse effects of esketamine have been summarized to provide a comprehensive reference for its rational clinical use. This study searched core databases, including PubMed, Embase, the Cochrane Library, and Web of Science. The search terms included esketamine, S-ketamine, anesthesia, analgesia, and depression, using a combined logical search of subject terms and free terms. The search period spanned from the establishment of each database through June 2025. Esketamine has since gained increasing popularity for surgical anesthesia, analgesia, and pain management because of its potent analgesic and anesthetic properties. Esketamine is important not only for anesthesia and analgesia in surgical patients during the perioperative period but also for broader applications in intensive care and emergency care, particularly in the treatment of mental illness. Therefore, Esketamine offers a broader and safer application prospect in surgical anesthesia, perioperative pain management, medication for special populations, and psychiatric disorders.