To investigate the effects of remimazzolam besylate combined with sufentanil on postoperative cognitive function, recovery quality, and inflammatory mediators in elderly patients undergoing laparoscopic inguinal hernia repair.

This study adopted a prospective, randomized, controlled, single-blind clinical trial design. A total of 200 elderly patients who underwent laparoscopic hernia repair at the Fifth People's Hospital of Yibin between January 2022 and September 2025 were enrolled. Patients were randomly assigned into an observation group and a control group using a simple random sampling method, with 100 cases in each group. The control group received propofol combined with sufentanil anesthesia, while the observation group received remimazolam besylate combined with sufentanil anesthesia. Cognitive function was assessed preoperatively and at 24 and 48 hours postoperatively. The quality of recovery (including awakening time and extubation time), levels of inflammatory mediators [tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-1β, and S100β protein] before surgery and at 24 hours postoperatively, and the incidence of adverse reactions before discharge were compared between the two groups.

At 24 and 48 hours postoperatively, the Montreal Cognitive Assessment (MoCA) scores and Mini-Mental State Examination (MMSE) scores in the observation group were higher than those in the control group (P<0.05). The awakening time and extubation time in the observation group were shorter than those in the control group (P<0.05). At 24 hours postoperatively, the serum levels of TNF-α, IL-6, IL-1β, and S100β protein in the observation group were lower than those in the control group (P<0.05; partial η² values for between-group effects were 0.05, 0.03, 0.05, and 0.04, respectively). There was no statistically significant difference in the overall incidence of adverse reactions between the two groups (P=0.469; effect size Cramer's V=0.05).

Remimazolam besylate combined with sufentanil can improve postoperative cognitive function, enhance the quality of recovery, and reduce inflammatory mediators in elderly patients undergoing laparoscopic hernia repair.