Clinical applications of esketamine: Current status and future perspectives.
Hui Li, Jingjing Deng, Tao Liu, Yuenong Zhang
Journal of International Medical Research March 29, 2026 DOI: 10.1177/03000605261432759 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Peer reviewed |
|---|---|
| Topics | Esketamine Ketamine |
| Key findings | Esketamine offers broader and safer application prospects than ketamine for surgical anesthesia, perioperative pain management, special populations, and psychiatric disorders. |
Abstract
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.
Comparable studies
Other narrative reviews on esketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Long-term safety of ketamine and esketamine in treatment of depression | 2022 | Review | |
| Ketamine, Esketamine, and Arketamine: Their Mechanisms of Action and Applications in the Treatment of Depression and Alleviation of Depressive Symptoms. | 2024 | Review | |
| The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence. | 2023 | Review | |
| Variations in BDNF and Their Role in the Neurotrophic Antidepressant Mechanisms of Ketamine and Esketamine: A Review. Patients with depression | 2024 | Narrative review |
Citations in the library
Cites 12
- Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms Pharmacological Reviews June 26, 2018
- Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression JAMA Psychiatry June 5, 2019
- Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression JAMA Psychiatry December 27, 2017
- Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study American Journal of Psychiatry April 16, 2018
- Esketamine Nasal Spray for Rapid Reduction of Depressive Symptoms in Patients With Major Depressive Disorder Who Have Active Suicide Ideation With Intent: Results of a Phase 3, Double-Blind, Randomized Study (ASPIRE II) The International Journal of Neuropsychopharmacology August 26, 2020
and 7 more in the library