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Perioperative sub-anesthetic esketamine reduces postoperative depression and anxiety and improves sleep quality in acoustic neuroma patients.

In a randomized clinical trial of 77 patients undergoing acoustic neuroma surgery, esketamine significantly reduced the incidence of depression on postoperative day 1 (7.7% vs 31.6%, RR 0.24, 95% CI 0.08-0.80, p=0.008) and day 3 (0.0% vs 15.8%, p=0.031) compared to placebo. Anxiety and sleep disturbances were also significantly reduced, but no significant effects on immune function or pain were observed.

Last updated: Jul 8, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Effects of sub-anesthetic doses of esketamine on immune function and postoperative negative emotions in acoustic neuroma patients: a randomized clinical trial.

observational

Chen Z, Wang Y, Cong P, Wang L, Sun P, Li Z, Zhang H, Li G, Jiao F, Zhao J, Li L, Jin Y, Wu Q, Tian L, Jin Y · Annals of medicine (2026)

Participants: N/A
Duration: Postoperative day 1 and day 3
Intervention: Continuous intravenous infusion of esketamine at 0.2 mg·kg⁻¹·h⁻¹ during anesthesia, followed by 1 mg·kg⁻¹ esketamine as an adjuvant in patient-controlled intravenous analgesia (PCIA).
Outcome: Incidence of depression (HADS-D score > 7), anxiety (HADS-A), sleep disturbances, immune function, postoperative pain scores.
Effect Size: RR 0.24 (95% CI 0.08-0.80) for depression at POD1; RR 0.00 (95% CI 0.00-0.47) for depression at POD3.
Population: Patients undergoing acoustic neuroma (AN) surgery (n=77 completers; 39 esketamine, 38 placebo).

Result:

PubMed: 42396903DOI: 10.1080/07853890.2026.2692804

Mechanism Graph

Esketamine blocks NMDA receptors
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Modulates glutamatergic signaling
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Enhances synaptic plasticity and neurotrophic factors
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Result: Reduced postoperative depression and anxiety

Limitations

  • ⚠Single-center study with relatively small sample size
  • ⚠Short follow-up limited to early postoperative period (POD1 and POD3)

Frequently Asked Questions

What is the primary benefit of esketamine in acoustic neuroma surgery?▼

Esketamine significantly reduces early postoperative depression and anxiety and improves sleep quality, but does not affect immune function or pain relief.

What dose of esketamine was used in this trial?▼

Patients received a continuous intravenous infusion of 0.2 mg·kg⁻¹·h⁻¹ during anesthesia, followed by 1 mg·kg⁻¹ in patient-controlled intravenous analgesia.

How was depression measured in this study?▼

Depression was measured using the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D), with a score > 7 indicating depression.

Did esketamine improve immune function after surgery?▼

No, the study found no significant differences in immune function between the esketamine and placebo groups.

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References

  1. 1.Chen Z, Wang Y, Cong P, Wang L, Sun P, Li Z, Zhang H, Li G, Jiao F, Zhao J, Li L, Jin Y, Wu Q, Tian L, Jin Y. "Effects of sub-anesthetic doses of esketamine on immune function and postoperative negative emotions in acoustic neuroma patients: a randomized clinical trial.." Annals of medicine, 2026. PMID: 42396903 DOI: 10.1080/07853890.2026.2692804
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.