Effects of Esketamine on Postoperative Hospital Anxiety and Depression Scale Scores in Patients Undergoing Laparoscopic Radical Resection for Colorectal Cancer.

Key Takeaways for GI Nurses

• Perioperative esketamine (0.5 mg/kg at induction plus 1 mg/kg added to PCIA) significantly reduced postoperative anxiety and depression scores (HADS-A and HADS-D) on days 1 and 3 after laparoscopic colorectal cancer resection compared with standard care.
• Patients receiving esketamine also had lower 24-hour IL-6 levels, suggesting a potential attenuation of the postoperative inflammatory/stress response, alongside higher patient satisfaction scores.
• These findings support a growing role for adjunctive NMDA-receptor antagonists like esketamine in multimodal analgesia protocols, which endoscopy and perioperative nurses should be aware of when managing PCIA pumps and monitoring for psychomimetic side effects (e.g., dissociation, sedation changes).
• Nurses play a critical role in early recognition and documentation of mood changes using HADS or similar screening tools, as this study reinforces that psychological recovery is a measurable, modifiable outcome tied to anesthetic technique.

Clinical Relevance

Postoperative anxiety and depression are common but often underrecognized complications following major abdominal oncologic surgery, including laparoscopic colorectal cancer resection. These psychological sequelae can delay mobilization, impair sleep, and reduce overall satisfaction with the surgical experience. This study demonstrates that a relatively simple, low-dose esketamine protocol integrated into standard general anesthesia and PCIA can meaningfully reduce HADS-measured anxiety and depression in the immediate postoperative period. For GI and endoscopy nurses working in perioperative or same-day surgery units, this reinforces the importance of validated psychological screening tools as part of routine postoperative assessment, not just pain scores alone.

From an operational standpoint, nurses managing PCIA pumps should be aware that esketamine-containing regimens may require additional monitoring parameters, particularly for level of consciousness and dissociative or psychomimetic effects, which are known class effects of ketamine derivatives. While the abstract notes no significant difference in complication rates, vigilant nursing assessment remains essential when a new adjunct is introduced into analgesic protocols. Additionally, the observed reduction in IL-6, an inflammatory marker linked to surgical stress response, suggests esketamine may have benefits beyond mood modulation, potentially supporting faster physiologic recovery, though this requires further correlation with clinical recovery metrics like mobility and length of stay.

For nursing professional development, this study highlights an evolving area of perioperative pharmacology where nurses can serve as key advocates for holistic recovery, addressing both physical and psychological dimensions of postoperative care. Understanding the rationale behind esketamine use enables nurses to better educate patients preoperatively about expected mood and analgesia benefits, improving informed consent discussions and potentially enhancing the patient satisfaction scores this study specifically measured.

Bottom Line

Adding low-dose esketamine during induction and PCIA for laparoscopic colorectal cancer surgery appears to meaningfully reduce early postoperative anxiety and depression while improving patient satisfaction, giving GI and perioperative nurses a practical, evidence-based reason to incorporate psychological screening and heightened monitoring into standard post-surgical nursing assessments.