Esketamine at induction lowered anxiety and depression scores after colorectal resection

Design

prospective, randomised, placebo-controlled single-centre trial, 1:1 allocation

Population

adults undergoing elective laparoscopic radical resection for colorectal cancer

Primary outcome

Hospital Anxiety and Depression Scale score on postoperative day 1

Effect

lower anxiety and depression subscale scores on days 1 and 3 and lower 24-hour interleukin-6 (all p < 0.05); magnitudes not reported

Adults undergoing elective laparoscopic radical resection for colorectal cancer were randomised 1:1 to conventional general anaesthesia with patient-controlled intravenous analgesia, or to the same plus esketamine 0.5 mg/kg at induction and 1 mg/kg added to the analgesia pump. The primary outcome was the Hospital Anxiety and Depression Scale score on the first postoperative day.

The esketamine group had lower anxiety and depression subscale scores on days 1 and 3, lower interleukin-6 at 24 hours, and higher satisfaction, all reported as p < 0.05. The report does not give the actual score differences or confidence intervals, only that the comparisons were significant - which is a real limitation, because a statistically significant change on a 21-point subscale can be clinically trivial, and there is no way to judge that from what is published here.

Read this as a hypothesis-generating single-centre study. Distress around cancer surgery is undertreated and an intervention already in the anaesthetic room is an attractive idea, but day 1 and day 3 mood scores after major surgery are heavily influenced by pain and sedation, and the day 7 result is not reported in the abstract. Nothing here supports adding esketamine to reduce perioperative distress outside a trial.

• Do not change anaesthetic practice on this: single centre, no effect sizes reported.
• Ask whether early mood scores are separable from analgesia and sedation effects.
• Note the day 7 outcome was measured but not reported in the abstract.
• Interleukin-6 reduction is a biomarker, not a patient outcome.
• Perioperative psychological distress in cancer surgery remains worth screening for by direct assessment.

Why it matters

It raises a question worth a proper trial: whether an intervention already given in theatre can reduce the distress that follows cancer surgery.

Don't overread it

Single-centre, no effect sizes given, and day 1 to 3 mood scores after major surgery are confounded by pain and sedation.

The statistics, in plain English

A report of 'p < 0.05' with no effect size is close to uninformative for clinical purposes. The p value tells you a difference is unlikely to be chance; it says nothing about whether the difference is large enough to matter. Without the mean scores in each group, or a confidence interval, a reader cannot tell a two-point change on a mood scale from a clinically meaningful one.

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