Abstract: Objective To observe the effects of remimazolam combined with alfentanil in elderly obese patients undergoing painless gastrointestinal endoscopy.Methods A total of 110 elderly obese patients who underwent painless gastrointestinal endoscopy in the hospital from January 2021 to December 2023 were divided into group A and group B according to the random number table method,with 55 cases in each group.Group A and group B were anesthetized with propofol combined with alfentanil and remifentanil combined with alfentanil,respectively.The sedation effect,gastrointestinal motility (serum gastrin and motilin concentrations),postoperative fatigue syndrome (POFS),induction time,examination time,recovery time,room exit time,and intraoperative adverse reactions were compared between the two groups.Results The excellent and good sedation rate in group B was 94.55%,higher than 81.82% in group A (P<0.05).Group B had shorter recovery time and room exit time [(8.26±1.73) min,(28.51±4.26) min] compared  to group A [(12.49±1.27) min,(37.63±5.45) min] (P<0.05).At the time of leaving the post-anesthesia care unit (T2),serum gastrin and motilin levels in group B [(97.53±18.81) pg/ml,(535.43±82.61) pg/ml] were higher than those in group A [(88.59±17.54) pg/ml,(504.62±83.19) pg/ml] (P<0.05).The duration of POFS in group B [(4.36±1.18) h] was longer than that in group A [(3.49±1.37) h] (P<0.05).There was no significant difference in the incidence of intraoperative adverse reactions between group B (7.27%) and group A (18.18%) (P>0.05).Conclusion The use of remimazolam combined with alfentanil in elderly obese patients undergoing painless gastrointestinal endoscopy provides better sedation,shorter recovery and room exit times,and less inhibition of excitatory gastrointestinal hormone secretion,which is beneficial for the recovery of gastrointestinal motility.However,the duration of POFS is longer.

Key words: gastrointestinal endoscopy, remimazolam, alfentanil, propofol, gastrointestinal motility, postoperative fatigue syndrome