Objective  To investigate the effect of appropriate dosage of remimazolam in combination with remifentanil on stress response and cognitive function in elderly patients gastrointestinal endoscopy.

Methods  Elderly patients undergoing gastrointestinal endoscopy in the Department of Anesthesiology and Pain of the First People's Hospital of Yongkang from June 2021 to June 2023 were selected as the study subjects and were divided into group A (0.15 mg·kg^-1), group B (0.20 mg·kg^-1) and group C (0.25 mg·kg^-1) according to the different doses of remimazolam. Modified alertness/sedation (MOAA/S) scores, anesthesia-related indexes (first sedation success, gastrointestinal endoscopy time awakening time, and discharge time), stress-related indexes [cortisol (COR), epinephrine (ADR) and adrenocorticotropic hormone (ACTH)], mini-mental status examination (MMSE) scores and anesthesia-related adverse reactions were compared among the three groups.

Results  A total of 186 patients were included in the study, with 62 patients in each group. The MOAA/S scores of groups B and C were significantly lower than those in group A (P<0.05) immediately after gastrointestinal endoscopy, 3 min and 6 min for gastroenteroscopy. The success rate of first sedation in groups B and C was significantly higher than that in group A, while the time of gastrointestinal endoscopy was significantly lower than that in group A, and the time of awakening and leaving the room were significantly longer than those in group A (P<0.05). The levels of COR, ADR and ACTH immediately after gastrointestinal endoscopy in groups B and C were significantly lower than those in group A (P<0.05). The MMSE scores of groups B and C at 10 min and 30 min after wake were significantly higher than those in group A (P<0.05). The total incidence of adverse reactions in group B was significantly lower than that in groups A and C (P<0.05).

Conclusion  0.20 mg·kg^-1 and 0.25 mg·kg^-1 remimazolam for geriatric gastrointestinal endoscopy have better sedative effect, can reduce the degree of stress response, and have less impact on cognitive function, but the dose of 0.25 mg·kg^-1 can lead to an increase in the incidence of hypotension and hypoxemia, and the recommended dose of remimazolam in geriatric gastrointestinal endoscopy is 0.20 mg·kg^-1.

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