Esketamine is a kind of pure dextroisomer of ketamine, compared with ketamine, the classic intravenous anesthetic, esketamine has a higher affinity to NMDA and opioid μ receptors, has stronger analgesic effect, and less respiratory depression, incidence of cardiovascular and psychiatric adverse reactions. It is also suitable for the clinical treatment of a variety of psychiatric disorders, such as epilepsy and depression. Effectively relieve patients' pain, improve patients' sleep quality, so as to achieve better treatment effect. It has gradually become an important non-opioid drug in perioperative low opioid program because of its strong analgesic effect, few adverse reactions, no influence of analgesic dose on respiratory and circulation stability, and little influence on mental state and cardiovascular system of patients. This article reviews the pharmacological properties, clinical applications and adverse reactions of esketamine.