Esketamine combined with low-dose propofol induction strategy for category-1 cesarean section: a case series
Abstract Background General anesthesia (GA) is the most accepted option for category-1 emergency cesarean sections (CSs). A low dose of esketamine has been used as an excellent adjunct to neuraxial anesthesia (NA) with little effect on newborns. However, literature on the use of esketamine for GA in...
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2025-05-01
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| Online Access: | https://doi.org/10.1186/s12871-025-03098-8 |
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| author | Guang-Qiu Zhu Yu Wang Xiao-Xia Wang Hai-Tao Cong Wan-Lan Mou |
| author_facet | Guang-Qiu Zhu Yu Wang Xiao-Xia Wang Hai-Tao Cong Wan-Lan Mou |
| author_sort | Guang-Qiu Zhu |
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| description | Abstract Background General anesthesia (GA) is the most accepted option for category-1 emergency cesarean sections (CSs). A low dose of esketamine has been used as an excellent adjunct to neuraxial anesthesia (NA) with little effect on newborns. However, literature on the use of esketamine for GA induction in emergency CS is limited. This case series describes our experience with an esketamine-based combined low-dose propofol induction strategy for category-1 CS. Methods We retrospectively analyzed esketamine-based anesthesia induction for category-1 emergency CS at our hospital between November 2022 and November 2024. Modified rapid sequence induction included 0.5 mg/kg esketamine, 1 mg/kg propofol, and 1 mg/kg rocuronium, respectively. Anesthesia was maintained by propofol infusion at 4 mg/kg/h and inhalation of 1.5% sevoflurane. The dose of propofol and sevoflurane was adjusted to maintain the BIS value at 40–60. Results The final cohort comprised 11 patients. The median 1-minute Apgar score was 9 points [range, 6–10], and the 5-minute Apgar score was 10 points for all newborns. The mean decision-to-delivery interval (DDI) was 10.9 ± 2.4 min. Only one newborn required temporary mask ventilation due to acute fetal distress, mainly caused by major placental abruption. No newborns were admitted to the intensive care unit (ICU). No episodes of hypotension (MAP < 70 mmHg) were observed from anesthesia induction to delivery of the newborns. In all cases, there was no intraoperative awareness, reflux aspiration, or adverse psychiatric effects. Conclusions The esketamine-based combination low-dose propofol induction strategy can effectively maintain maternal hemodynamic stability without causing neonatal depression, making it suitable for category-1 emergency CSs. However, further randomized controlled trials are needed to confirm these findings. |
| format | Article |
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| institution | DOAJ |
| issn | 1471-2253 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | BMC Anesthesiology |
| spelling | doaj-art-5544e448c9a34ecdb6a52fab8a9d955e2025-08-20T03:09:19ZengBMCBMC Anesthesiology1471-22532025-05-012511510.1186/s12871-025-03098-8Esketamine combined with low-dose propofol induction strategy for category-1 cesarean section: a case seriesGuang-Qiu Zhu0Yu Wang1Xiao-Xia Wang2Hai-Tao Cong3Wan-Lan Mou4Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityDepartment of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityDepartment of Obstetrics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityDepartment of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityDepartment of Operation Room, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityAbstract Background General anesthesia (GA) is the most accepted option for category-1 emergency cesarean sections (CSs). A low dose of esketamine has been used as an excellent adjunct to neuraxial anesthesia (NA) with little effect on newborns. However, literature on the use of esketamine for GA induction in emergency CS is limited. This case series describes our experience with an esketamine-based combined low-dose propofol induction strategy for category-1 CS. Methods We retrospectively analyzed esketamine-based anesthesia induction for category-1 emergency CS at our hospital between November 2022 and November 2024. Modified rapid sequence induction included 0.5 mg/kg esketamine, 1 mg/kg propofol, and 1 mg/kg rocuronium, respectively. Anesthesia was maintained by propofol infusion at 4 mg/kg/h and inhalation of 1.5% sevoflurane. The dose of propofol and sevoflurane was adjusted to maintain the BIS value at 40–60. Results The final cohort comprised 11 patients. The median 1-minute Apgar score was 9 points [range, 6–10], and the 5-minute Apgar score was 10 points for all newborns. The mean decision-to-delivery interval (DDI) was 10.9 ± 2.4 min. Only one newborn required temporary mask ventilation due to acute fetal distress, mainly caused by major placental abruption. No newborns were admitted to the intensive care unit (ICU). No episodes of hypotension (MAP < 70 mmHg) were observed from anesthesia induction to delivery of the newborns. In all cases, there was no intraoperative awareness, reflux aspiration, or adverse psychiatric effects. Conclusions The esketamine-based combination low-dose propofol induction strategy can effectively maintain maternal hemodynamic stability without causing neonatal depression, making it suitable for category-1 emergency CSs. However, further randomized controlled trials are needed to confirm these findings.https://doi.org/10.1186/s12871-025-03098-8EsketaminePropofolCesarean sectionEmergencyGeneral anesthesia |
| spellingShingle | Guang-Qiu Zhu Yu Wang Xiao-Xia Wang Hai-Tao Cong Wan-Lan Mou Esketamine combined with low-dose propofol induction strategy for category-1 cesarean section: a case series BMC Anesthesiology Esketamine Propofol Cesarean section Emergency General anesthesia |
| title | Esketamine combined with low-dose propofol induction strategy for category-1 cesarean section: a case series |
| title_full | Esketamine combined with low-dose propofol induction strategy for category-1 cesarean section: a case series |
| title_fullStr | Esketamine combined with low-dose propofol induction strategy for category-1 cesarean section: a case series |
| title_full_unstemmed | Esketamine combined with low-dose propofol induction strategy for category-1 cesarean section: a case series |
| title_short | Esketamine combined with low-dose propofol induction strategy for category-1 cesarean section: a case series |
| title_sort | esketamine combined with low dose propofol induction strategy for category 1 cesarean section a case series |
| topic | Esketamine Propofol Cesarean section Emergency General anesthesia |
| url | https://doi.org/10.1186/s12871-025-03098-8 |
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