Abstract: Objective To investigate the effects of different doses of esketamine on early postoperative depression and recovery quality in patients undergoing radical surgery for cervical cancer. 
Methods A total of 116 patients scheduled for radical surgery for cervical cancer under general anesthesia were included, with 29 patients in each group. After induction of anesthesia, patients in groups A, B, and C received intravenous injections of esketamine at doses of 0.1 mg/kg, 0.2 mg/kg, and 0.4 mg/kg, respectively, at 10 min before skin incision, while group N (control group) received an equivalent volume of normal saline. The self-rating depressive scale (SDS) was used to assess depressive state on the day before surgery and at 1 d, 3 d, 5 d, and 7 d after surgery. The 15-item quality of recovery scale (QoR-15) was used to evaluate recovery quality. Intraoperative use of remifentanil, time from drug discontinuation to extubation, postoperative visual analogue scale (VAS) scores within 72 h after surgery, rescue analgesia rate, length of postoperative hospital stay, and adverse events of the four groups were recorded. 
Results The incidence of postoperative depression in groups B and C was significantly lower than that in group N, and the incidence in group C was significantly lower than that in group A (P＜0.05). Over time, SDS scores decreased in all four groups. Group B had lower SDS scores than group N at 1 d and 3 d after surgery, while group C had lower SDS scores than group N at 1 d, 3 d, 5 d, and 7 d after surgery. Significant differences in interaction were observed between groups, time points, and time points between groups (P＜0.05). QoR-15 scores increased over time in all groups, with group C showing higher scores than group N at 1 d after surgery; significant differences in interaction were found between groups and time points (P＜0.05), but there was no significant difference in interaction between groups and time points (P＞0.05). VAS scores decreased over time in all groups, with group C exhibiting lower scores than group N at 12 h, 24 h, and 48 h after surgery, and lower scores than group A at 12 h and 24 h after surgery. Significant differences in interaction were observed between groups, time points, and time points between groups (P＜0.05). Group C had lower remifentanil consumption than group N, and groups B and C had lower rescue analgesia rates within 72 h after surgery than group N (P＜0.05). VAS scores fluctuated over time in all groups, with significant differences in interaction between time points (P＜0.05), but no significant differences in interaction between groups and time points between groups (P＞0.05). No significant differences were observed in other indicators or adverse events among the four groups (P＞0.05). 
Conclusion The intraoperative use of esketamine not only helps alleviate early postoperative depressive symptoms in cervical cancer patients but also reduces intraoperative opioid consumption, mitigates postoperative pain, and improves recovery quality, aligning with the principles of enhanced recovery after surgery. The optimal effect is achieved at a dose of 0.4 mg/kg.

Key words: cervical neoplasms, depression, esketamine