This review explores the regulatory mechanism of anesthesia on the perioperative immune response and its impact on postoperative recovery and complications in patients. Surgical trauma can activate the body’s immune defense and tissue repair mechanisms, but excessive or imbalanced inflammatory reactions can easily lead to immune suppression, immune tolerance, and organ dysfunction. Anesthesia significantly affects the process by regulating cytokine release, immune cell activity, and the inflammatory microenvironment. The rational use of general anesthetics (eg, propofol and volatile anesthetics) and opioids can suppress excessive inflammation, while improper use may exacerbate immune suppression; regional anesthesia results in less immune interference than general anesthesia. Excessive inflammation is closely related to increased postoperative pain, delayed physical recovery, prolonged hospitalization, infection, cardiac complications, acute kidney injury, and other factors. The current regulation strategies include optimizing the anesthesia scheme (selecting appropriate drugs and methods, as well as regulating the depth of anesthesia), using anti-inflammatory drugs and immunomodulators, strengthening nutritional support, etc. In the future, it is necessary to focus on the clinical translation of new therapies such as immune checkpoint inhibitors, optimize perioperative immune management through multidisciplinary collaboration, and improve long-term patient prognosis.