Effect of esketamine on hypotension in women with preoperative anxiety undergoing elective cesarean section: a randomized, double-blind, controlled trial

To investigate the effect of low-doses esketamine on spinal anesthesia-induced hypotension in women with preoperative anxiety undergoing elective cesarean section, the randomized controlled trial enrolled 120 women aged 18-35 years who preoperative State-Trait Anxiety Inventory State scores > 40, conducted from September 2022 to August 2023 in Xuzhou Central Hospital, China. Women in the esketamine group received a single intravenous injection of 0.2 mg/kg esketamine after sensory block level achieved. The incidence of hypotension in the esketamine group was significantly lower than the control group at T2 (10% 6 of 60; P < 0.001), T3 (5.0% 3 of 60; P = 0.007) and T4(5.0% 3 of 60; P = 0.004). Despite being higher in the esketamine group, the overall rates of hypertension (11.7% 7 of 60; P = 0.186), tachycardia (23.3% 14 of 60; P = 0.246), and bradycardia (0.0% 0 of 60; P = 0.079) were no significantly difference between the two groups. STAI-S scores was significantly lower in the esketamine group (mean SD 37.527.14) than in the control group (mean SD 41.039.66, P = 0.39) in postoperative day 1. Spinal anesthesia combined with intravenous low-doses esketamine infusion can significantly reduce the incidence of hypotension in women with preoperative anxiety undergoing elective cesarean section.