Abstract: Objective To evaluate the effect of low-dose esketamine on the quality of recovery from anesthesia in patients undergoing transnasal transsphenoidal pituitary tumor resection. Methods A total of 60 patients who were scheduled for transnasal transsphenoidal pituitary tumor resection were enrolled. They were randomly divided into two groups (n=30): an esketamine group (group R) and a control group (group S). After anesthesia induction, group R was intravenously administered with 0.15 mg/kg esketamine followed by pumping at a rate of 5 μg·kg^-1·min^-1 until 15 min before the end of operation. Meanwhile, group S was administered with normal saline. The incidence and severity of coughing during the recovery period, Ricker sedation agitation score (SAS), agitation incidence, VAS score, and rescue analgesia rate were recorded. Results Compared with group S, group R showed remarkable decreases in the incidence and severity of coughing, and reduction in SAS scores, VAS scores and rescue analgesia rate (P<0.05). There was no statistical difference in agitation incidence (P>0.05). The hemodynamics in group R during extubation were more stable lower than those in group S (P<0.05). There was no significant difference in eye-opening time, extubation time and adverse event incidence between the two groups (P>0.05). Conclusions During transnasal transsphenoidal pituitary tumor resection, continuous infusion of low dose esketamine can reduce the incidence and severity of coughing, reduce postoperative pain, and does not increase adverse reactions, which is beneficial to improve the quality of recovery from anesthesia.