Abstract: Objective To explore the protective effect of induction of anesthesia with esketamine on postoperative cognitive function in patients undergoing laparoscopic total hysterectomy (LTH). 
Methods A total of 80 patients undergoing LTH admitted to Department of Gynecology of the First Hospital of Huai′an Affiliated to Nanjing Medical University were randomly divided into group A and group B. Group A consisted of 40 patients who received anesthesia induction with ciprofol and sufentanil, while group B consisted of 40 patients who received anesthesia induction with ciprofol and esketamine. The vital signs ［mean arterial pressure(MAP), heart rate(HR)］, cognitive function ［mini-mental state examination (MMSE)］ scores, depressive state ［self-rating depression scale (SDS)］ scores, sleep quality ［Pittsburgh Sleep Quality Index (PSQI)］ scores, and adverse reactions (nausea, vomiting, respiratory suppression, delayed awakening, shivering, restlessness) of the two groups were compared. 
Results The average MAP and HR of the two groups after tracheal intubation, at 1 min and 30 min after skin incision were lower than those before anesthesia induction, while MAP and HR of group B were higher than those of group A at the same time period; there were significant differences in interaction between groups, time points and time points between groups (P＜0.05). The MMSE scores of the two groups at 1 d and 3 d after operation were lower than those before operation,which were higher in group B than in group A at the same time period; there were significance differences in interaction between groups, time points and time points between groups (P＜0.05). SDS scores of the two groups at 1 d and 3 d after operation were higher than those before operation, which were lower in group B than in group A at the same time period; there were differences in interaction between groups, time points and time points between groups (P＜0.05). PSQI scores of the two groups at 1 d and 3 d after operation were higher than those before operation, which were lowerin group B than in group A at the same time period; there were significance differences in interaction between groups, time points and time points between groups (P＜0.05).The incidence of adverse reactions in group B was lower than that in group A (P＜0.05). 
Conclusion The application of ciprofol combined with esketamine anesthesia induction in LTH has a good effect, which can stabilize the patient′s intraoperative vital signs, reduce the impact on their cognitive function, psychological state, and sleep quality, and has fewer adverse reactions. Therefore, it is worthy of promotion. 

Key words: hysterectomy, laparoscopy, esketamine