Abstract: Objective Observation of the value of remazolam mesylate in endoscopic varicose vein ligation under general anesthesia in elderly patients with cirrhosis. Methods 160 cases of elderly cirrhotic patients who underwent endoscopic varicose vein ligation under general anesthesia in our hospital from January 2022 to December 2024 were selected and divided into two groups using a random number table. The control group was given propofol anesthesia induction and maintenance, and the observation group was given remazolam mesylate anesthesia induction and maintenance. Differences in hemodynamic parameters, operative time, anesthetic recovery time, vasoactive drug use rate, cumulative postoperative cognitive dysfunction (POCD) incidence, and incidence of adverse reactions were compared between the two groups. Results There was no difference in hemodynamic comparison between the two groups at preoperative (T0) (P>0.05). Mean arterial pressure (MAP) and heart rate (HR) were lower at intraoperative nadir (T1) than at T0 in both groups, but were higher at T1 in the observation group than in the control group (P<0.05). Blood oxygen saturation (SpO₂) at T1 and immediate postoperative (T2) was higher than at T0 in both groups, but there was no difference between the two groups (P>0.05). There was no difference between the two groups in MAP and HR at T2 compared to T0 within each group, and no significant difference between the two groups at T2 (P>0.05). The recovery time of consciousness (4.21±1.29) min and PACU stay (12.33±3.16) min in the observation group were shorter than those in the control group, and the cumulative POCD incidence rate in the 5d postoperative period (5.00%) was lower than that in the control group (P<0.05), and the operative time, the rate of use of vasoactive drugs, and the cumulative POCD incidence rate in the observation group in the 1d postoperative period and 3d postoperative period compared with those in the control group(P>0.05). There was no difference in the incidence of adverse reactions between the observation group and the control group (P>0.05). Conclusion The use of remazolam mesylate in general anesthesia for endoscopic varicose vein ligation stabilizes intraoperative hemodynamics, promotes awakening, and reduces postoperative POCD in elderly cirrhotic patients.

Key words: Remazolam mesylate, Endoscopic varicose vein ligation, Cirrhosis, Hemodynamics, Cognitive dysfunction