The volume of gynecological and obstetric surgeries is large, and the high rates of adverse events incidence such as perioperative cycle fluctuations, postoperative nausea and vomiting and adverse emotional experiences, which is a concern for clinicians. Esketamine is a right-handed isomer of ketamine with a strong affinity for the N-methyl-D-aspartate receptor (NMDAR), which has a rapid anesthetic, analgesic and antidepressant effect. It can be administered through multiple routes and has been widely used in clinical anesthesia, postoperative analgesia and depression treatment. The application of esketamine injection in clinical practice is still relatively short, and the benefits and mechanisms during perioperative application have not been fully elucidated, making it a research hotspot in recent years. Many studies have reported that the application of esketamine injection in obstetrics and gynecology surgery can stabilize circulation, and reduce respiratory depression, nausea and vomiting and other adverse reactions. It is also beneficial for the prevention and treatment of postpartum depression under certain conditions, but sometimes there are also temporary pseudo-psychiatric symptoms and other adverse reactions. In this article, we review the pharmacological effects, perioperative application and impact on postoperative recovery of esketamine based on the specialty characteristics of obstetrics and gynecology surgery, and clarify its current application status, as well as possible clinical applications and research directions in the future, to provide reference for the clinicians.

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