To investigate the effects of remimazolam besylate combined with sufentanil in elderly patients undergoing laparoscopic inguinal hernia repair.

This study is a prospective, non-randomized controlled trial. A total of 100 elderly patients scheduled for laparoscopic inguinal hernia repair at the Second Hospital of Tianjin Medical University from January 2024 to January 2026 were included. Patients were alternately assigned according to the time of enrollment into an experimental group (remimazolam besylate combined with sufentanil, n=50) or a control group (propofol combined with sufentanil, n=50) using convenient sampling (those with odd numbers were assigned to the control group, while those with even numbers were assigned to the experimental group). This study adopted a single blind design. Cognitive function [Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE)], sedation and analgesic effects [Ramsay Sedation Scale (RSS) score, Visual Analogue Scale (VAS) score], and serum stress response indicators [adrenaline, norepinephrine (NE), cortisol] were assessed before surgery, and at 24 hours and 48 hours after surgery. Perioperative hemodynamic parameters [mean arterial pressure (MAP) and heart rate at 5 min before anesthesia induction (T0), 5 min after tracheal intubation (T1), 5 min after pneumoperitoneum establishment (T2), and 5 min after tracheal extubation at the end of surgery (T3)] were recorded. The perioperative consumption of anesthetics and the occurrence of perioperative complications were also recorded.

Compared with the control group, the experimental group exhibited higher scores in the primary outcome indicator (24 h postoperative MoCA score) and secondary outcome indicators (48 hours postoperative MoCA score, as well as 24 and 48 hours postoperative MMSE scores). At 24 and 48 hours after surgery, the experimental group had better RSS and VAS scores, alongside lower serum levels of adrenaline, NE and cortisol; all differences were statistically significant (P<0.05). The MAP and heart rate at T1 and T2 were more stable in the experimental group than in the control group (P<0.05). The total perioperative propofol consumption was significantly lower in the experimental group than that in the control group (P<0.001). There was no statistically significant difference in the overall incidence of perioperative complications between the two groups (χ²=1.084, P=0.298).

This study preliminarily indicates that remimazolam besylate combined with sufentanil in elderly patients undergoing laparoscopic inguinal hernia repair can improve early postoperative cognitive function, offer reliable sedation and analgesia, stabilize hemodynamics and attenuate postoperative stress response, with no elevated risk of serious adverse events. However, further large-sample, multicenter randomized controlled trials are required to confirm these findings.