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

TL;DR

Sub-anesthetic esketamine given perioperatively to acoustic neuroma surgery patients reduced postoperative depression, anxiety, and sleep disturbances at days 1–3, with no impact on immune function, pain control, or safety profile.

Key findings

• Esketamine reduced POD1 depression incidence from 31.6% to 7.7% (RR 0.24) and POD3 depression from 15.8% to 0% (RR 0.00)
• Anxiety on POD1/3 and sleep disturbances on POD1 were significantly reduced with esketamine vs. placebo
• No significant differences in early immune function markers, postoperative pain scores, or opioid requirements between groups
• Adverse event profiles were similar between esketamine and placebo groups

Why this matters at the bedside

May inform perioperative management of acoustic neuroma patients at high risk for postoperative psychiatric morbidity; however, the lack of immune or analgesic benefit and reliance on mood symptom scales alone limit broader applicability. Results are specific to this neurosurgical population.