Dexmedetomidine-Esketamine Combination on Depression and Anxiety After Laparoscopic Ureteral Reconstruction

Ureteral stricture (US) is characterized by narrowing of the ureteral lumen, which canlead to upper urinary tract obstruction and subsequent renal impairment. The primarytherapeutic goal of US is to relieve obstruction and preserve renal function. Currenttreatment methods include endoscopic balloon dilation, endoureterotomy, ureteraldilation, and ureteral reconstruction surgery. Among these, ureteral reconstructionsurgery is highly effective, especially for complex strictures exceeding 2 cm in length.Patients with US often endure prolonged symptom burden and substantial medical costs, andare prone to emotional disturbances such as anxiety and depression. A multicenterprospective study reported that the preoperative prevalence of anxiety and depressivesyndromes in US patients scheduled for surgery was 31.3% and 20.7%, respectively, withiatrogenic US and urinary symptoms being the strongest predictors of increased levels ofanxiety and depression. Perioperative stress may further exacerbate the severity ofanxiety and depressive symptoms, leading to increased intraoperative anesthetic andanalgesic requirements, delayed emergence from anesthesia, and higher risks ofpostoperative delirium and sleep disturbances.Dexmedetomidine is a highly selective α2‐adrenergic receptor agonist with sedative,analgesic, and anxiolytic properties. It also exerts antidepressant effects throughmultiple mechanisms. Clinical studies have confirmed its efficacy in alleviatingpostoperative anxiety and depression across various surgical populations. Esketamine, theS‐enantiomer of ketamine, is an N‐methyl‐D‐aspartate (NMDA) receptor antagonist withanesthetic, analgesic, and rapid‐onset antidepressant effects. Perioperative studies alsoconfirmed the efficacy of esketamine in relieving postoperative depressive symptoms.Routine dose esketamine may cause psychiatric side effects such as dissociative symptomsand hallucinations; administration of low‐dose esketamine attenuates these side effectsbut may weaken the antidepressant efficacy. The sedative properties of dexmedetomidinecan mitigate the side effects of esketamine. Furthermore, the combined use of low‐dosedexmedetomidine and esketamine may offer synergistic anxiolytic and antidepressanteffects with a favorable safety profile.This study is designed to test the hypothesis that perioperative administration oflow‐dose dexmedetomidine‐esketamine combination may relieve postoperative depressive andanxiety symptoms in patients undergoing laparoscopic ureteral reconstruction for US.