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Background: Patients undergoing surgery for gastric cancer are at high risk for postoperative anxiety and depression, which can significantly impact recovery and quality of life. Opioid-based anesthesia, while effective for pain control, may contribute to emotional dysregulation and mood disturbances. This study explores the effects of an esketamine combined with low-opioid anesthesia regimen on postoperative mental health outcomes in patients undergoing laparoscopic surgery for gastric cancer. Objective: To evaluate the impacts of this regimen on postoperative anxiety and depression levels, alongside blood pressure, heart rate, respiratory circulation, and overall emotional well-being. Methods: A total of 246 patients undergoing laparoscopic surgery for gastric cancer were randomly divided into two groups: the conventional anesthesia group (n = 123) and the esketamine group (n = 123). Vital signs (SBP, DBP, HR, SpO2) were compared at four time points (T0-T3). The dosages of sufentanil and remifentanil, and PCIA drug additional administration rates were compared, along with anxiety and depression levels assessed by SAS and SDS at multiple postoperative time points to track emotional recovery. Results: Significant differences were found in SBP, DBP, HR, SpO2, SAS, and SDS between the two groups (P < 0.05). The esketamine group showed higher vital signs at T1–T3 and consistently lower SAS and SDS scores postoperatively. Lower opioid dosages and PCIA drug additional administration rates were observed in the esketamine group (P < 0.05). Most notably, the esketamine group demonstrated a significantly more favorable trajectory in anxiety and depression recovery. Conclusion: Esketamine-assisted low-opioid anesthesia not only reduces opioid dosage and stabilizes vital signs but also provides a significant mental health benefit by effectively mitigating postoperative anxiety and depression in patients undergoing laparoscopic gastric cancer surgery. This highlights its dual role in supporting both physical and psychological recovery.
