To explore the anesthetic effect and safety of remimazolam combined with dexmedetomidine nasal drops in pediatric laparoscopic high ligation of hernia sac surgery.

This study was a retrospective cohort study. We retrospectively analyzed the clinical data of 201 children with indirect inguinal hernia who underwent laparoscopic high ligation of the hernial sac at Xi'an Children's Hospital from March to December 2025. The patients were divided into an experimental group (n=101) and a control group (n=100) according to the anesthesia regimen. The experimental group received remimazolam combined with dexmedetomidine nasal drops for anesthesia, while the control group received propofol combined with dexmedetomidine nasal drops for anesthesia. The heart rate, mean arterial pressure (MAP), oxygen saturation (SpO₂), anesthesia induction time, recovery time, length of stay in the post-anesthesia care unit (PACU), and anesthesia-related adverse reactions were compared between the two groups at four time points: before anesthesia induction (T₀), 5 minutes after induction (T₁), 5 minutes after the start of surgery (T₂), and at the end of surgery (T₃).

Repeated-measures analysis of variance showed that there were statistically significant differences in the fluctuation ranges of heart rate and MAP between the two groups of children at different time points in terms of inter-group effect (F_group=5.824, 3.837; P_group=0.005, 0.015), time effect (F_time=2.975, 7.387; P_time=0.018, 0.006), and interaction effect (F_interaction=3.718, 3.539; P_interaction=0.002, 0.025). Further pairwise comparisons with Bonferroni correction in simple effect analysis revealed that, compared with T0, heart rate and MAP decreased at T1 and increased at T2 and T3 in both groups. However, the fluctuation ranges of heart rate and MAP at all time points in the experimental group were significantly smaller than those in the control group (P<0.05). For SpO₂, there were no statistically significant differences in the inter-group effect (F_group=2.141, P_group=0.061), time effect (F_time=6.264, P_time=0.089), and interaction effect (F_interaction=2.911, P_interaction=0.117) (all P>0.05). The anesthesia induction time, awakening time, and PACU stay time in the experimental group were shorter than those in the control group (t=2.362, 19.634, 2.259; all P<0.05). There was no statistically significant difference in the total incidence of anesthesia-related adverse reactions between the experimental group and the control group (7.92% vs 10.00%; χ²=0.266, P=0.606).

Remimazolam combined with dexmedetomidine nasal drops is used for pediatric laparoscopic high ligation of hernia sacs. The anesthetic effect is rapid, the recovery is swift, it can stabilize the perioperative hemodynamics, the incidence of adverse reactions is low, and the safety is high.