Obstetric and gynecological anesthesia requires a delicate balance between maternal safety and fetal/neonatal health. Traditional anesthetic methods have limitations in analgesic efficacy, physiological interference, and neonatal effects. In recent years, novel anesthetic agents such as esketamine and dexmedetomidine have emerged as promising options that may address some of these limitations. This narrative review synthesized evidence from a comprehensive literature search conducted in Public Medicine/Medical Literature Analysis and Retrieval System Online (PubMed/MEDLINE), Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Data (2005–2026, with emphasis on 2022–2026). Search strategies combined Medical Subject Headings (MeSH) terms and keywords including “esketamine”, “dexmedetomidine”, “obstetric anesthesia”, “gynecological anesthesia”, “cesarean section”, “labor analgesia”, “postpartum depression (PPD)”, and “opioid-sparing anesthesia”. Inclusion criteria were original research (randomized controlled trials, cohort studies), systematic reviews, meta-analyses, and clinical guidelines. A total of 107 articles were included after full-text review. As an N-methyl- D -aspartate (NMDA) receptor antagonist, esketamine offers effective analgesia, anti-hyperalgesia, and rapid antidepressant effects. Preliminary evidence suggests that low-dose esketamine may be associated with reduced risk of PPD. Dexmedetomidine, through highly selective α₂ receptor agonism, provides “awake sedation” with minimal respiratory effects. It enhances regional anesthesia efficacy, stabilizes hemodynamics, and reduces perioperative adverse reactions. Their combined use exhibits synergistic effects, enabling opioid reduction or even opioid-free analgesia, thereby potentially improving anesthetic safety and patient comfort. Current evidence, derived predominantly from moderate-sized studies in specific populations (e.g., Chinese cesarean delivery women), supports their utility in cesarean section anesthesia, labor analgesia, gynecological surgeries, and PPD prevention, though with important limitations. Safety profiles regarding placental transfer, neonatal outcomes, and breastfeeding exposure appear acceptable at recommended doses, yet evidence gaps remain, particularly regarding long-term neurodevelopmental outcomes in offspring. From esketamine to dexmedetomidine, the introduction of these novel anesthetic agents reflects an ongoing evolution in obstetric and gynecological anesthesia toward more comprehensive perioperative care. However, while evidence supports their role in enhancing analgesia and reducing opioid requirements, many proposed multidimensional benefits (e.g., organ protection, broad mental health effects) remain supported by preliminary evidence requiring confirmation in well-designed trials. Long-term neurodevelopmental outcome data in offspring are notably absent. Future directions include precision medication, artificial intelligence-assisted decision-making, and multidisciplinary collaboration for achieving personalized anesthesia and comprehensive perinatal health management.
Lei et al. (Fri,) studied this question.