To compare and analyze the application effects of remifentanil tosylate injection and propofol injection in painless endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients.

A total of 106 elderly patients who underwent painless ERCP for treatment were included in this study. After excluding 4 patients according to the inclusion criteria, 102 patients were finally included. They were divided into two groups based on the medication used: the remimazolam group and the propofol group, with 51 patients in each group. Both groups of patients received general intravenous anesthesia. The remimazolam group was anesthetized with remimazolam mesylate combined with sufentanil, while the propofol group was anesthetized with propofol combined with sufentanil. Compared the anesthesia induction time, induction success rate, intraoperative hemodynamics, anesthesia recovery time, hemodynamics, stress response indicators between two groups of patients, and the safty was comparied.

The anesthesia induction time of the remimazolam group was (5.12±1.23) min, which was significantly longer than that of the propofol group (3.39±0.92) min. The success rate of the first induction was 52.94%, which was significantly lower than that of the propofol group 80.00% (all P<0.05). The eye-opening time of the remimazolam group and the propofol group were (4.96±1.58) and (8.00±2.03)min, respectively; the time for consciousness recovery were (5.92±1.64) and (9.10±2.59)min, respectively; the tracheal extubation time were (10.08±2.87) and (13.06±3.12) minutes, respectively; the retention time in the recovery room were (21.22±5.18) and (26.35±5.83) min, respectively. The eye opening, consciousness recovery, tracheal extubation and retention time in the recovery room in the remimazolam group were all significantly shorter than those in the propofol group (all P<0.05). After the examination, the VAS scores of the remimazolam group and the propofol group were (2.61±0.69) and (3.14±0.81) points, respectively; the VAS score of the remimazolam group was lower than that of the propofol group (P<0.05). At 24 h after the operation, the levels of epinephrine (E) in the remimazolam group and the propofol group were (42.11±5.93) and (47.12±6.01) ng·mL^-1, respectively; the levels of norepinephrine (NE) were (67.28±7.84) and (72.46±8.10) ng·mL^-1, respectively; the cortisol (COR) levels were (105.43±11.25) and (111.23±12.34) ng·mL^-1, respectively. The E, NE and COR in the remimazolam group were all significantly lower than those in the propofol group (all P<0.05). The incidence of adverse drug reactions in the remimazolam group and the propofol group were 9.80% and 27.45%, respectively. The incidence of adverse drug reactions in the remimazolam group was lower than that in the propofol group (P<0.05).

Compared with propofol injection, the induction time of remifentanil tosylate injection for painless ERCP diagnosis and treatment in elderly patients is significantly longer than propofol injection, but the circulation after induction and during surgery is smoother, the stress response is lower, the recovery is rapid, and there are no serious adverse reactions. It can be clinically promoted and applied.