Abstract: Objective To investigate the application effect of remazolam besylate combined with alfentanil in painless gastrointestinal endoscopy in elderly patients. 
Methods A total of 208 elderly patients who were admitted to the hospital and planned to undergo painless gastrointestinal endoscopy were selected and divided into the research group (n=104) and the control group (n=104) according to the random number table method. The control group was anesthetized with propofol combined with alfentanil, and the research group was anesthetized with remazolam besylate combined with alfentanil. The recovery time, examination time, and time of leaving the room, and the blood pressure, heart rate, oxygen saturation at different time points ［before administration (T1), at 5 min after administration (T2), at 10 min after administration (T3), and at 15 min after administration (T4)］, sedative effects, and adverse reactions of the two groups were compared. 
Results The recovery time and the time of leaving the room in the research group were shorter than those in the control group (P＜0.05). The systolic pressure, diastolic pressure, heart rate, and blood oxygen saturation at T2 in both groups were lower than those at T1 (P＜0.05), and the systolic pressure, diastolic pressure, heart rate, and blood oxygen saturation at T2 in the research group were higher than those in the control group (P＜0.05) . The systolic pressure, diastolic pressure, heart rate and blood oxygen saturation at T3 and T4 in the control group were higher than those at T2 (P＜0.05). The excellent and good rate of sedative effect in the research group was higher than that in the control group (P＜0.05). The total incidence of adverse reactions in the research group was lower than that in the control group (P＜0.05). 
Conclusion Remazolam besylate combined with alfentanil for painless gastrointestinal endoscopy in elderly patients can shorten the recovery time, have less impact on hemodynamics, and have a low incidence of adverse reactions in patients, which is safe and reliable.

Key words: gastroscopy, colonoscopy, alfentanil