ObjectivesThe use of intravenous analgesics during emergency cesarean section may lead to adverse neonatal outcomes. In our study, we investigated whether a single intravenous (i.v.) dose of 25 mg esketamine administered to parturients with inadequate analgesia during epidural anesthesia for cesarean section would affect the neonate.DesignWe reviewed the records of parturients who were transferred from labor analgesia to epidural anesthesia for emergency cesarean section from January 2021 to April 2022. Parturients were grouped by whether they received esketamine infusions during the incision–delivery interval. Neonatal outcomes, including umbilical arterial-blood gas analysis (UABGA), Apgar score, and total days spent by the neonate in the hospital, were compared between the two groups. The secondary outcomes of this study included BP, heart rate (HR), SPO2and the incidence of adverse effects in parturients during operation.SettingChina.ResultsAfter propensity score matching, 31 patients remained in each of the non-esketamine and esketamine groups. There were no significant differences in neonatal outcomes, including UABGA, Apgar score, and total days in the hospital, between the two groups. Additionally, our study showed a similar hemodynamic performance in parturients between the two groups during operation.ConclusionsIntravenous esketamine (25 mg) is safe for neonates when it is given to parturients transferred from labor analgesia to emergency cesarean section.