Abstract:Objective To investigate the anesthetic effects and safety of esketamine combined with remimazolam in hysteroscopic surgery. Methods A total of 80 patients scheduled for hysteroscopic surgery undergoing intravenous general anesthesia from July 2023 to July 2024 at Wuxi 9th People's Hospital were prospectively selected and randomly divided into Group P (esketamine+propofol, n=40) and Group R (esketamine+remimazolam, n=40). The intraoperative motor response grading scores, blood pressure, heart rate, recovery time and adverse reactions of the two groups were compared. Results Compared with Group P, the proportion of patients with a motor response score ≥3 in the Group R was significantly higher [47.5% (19/40) vs 17.5% (7/40), χ²=8.205, P=0.004]and lowest and highest intraoperative systolic blood pressure in Group R were higher (P<0.01). The heart rate of Group R after anesthesia were faster than that of Group P (P<0.01). Compared with Group P, Group R had a shorter recovery time [ (3.6±1.4) min vs (6.4±1.7) min, t=8.200, P<0.01], and the lower incidence of injection pain [2.5% (1/40) vs 30.0% (12/40), χ²= 11.114,P<0.01], bradycardia [0 vs 15.0% (6/40), χ²=4.505, P=0.034]and hypotension [2.5% (1/40) vs 20.0% (8/ 40), χ²=4.507, P=0.034]. Conclusion The combination of esketamine and remimazolam is safe and effective for use in hysteroscopic surgery, offering stable circulation, short recovery time, and minimal adverse reactions, though it is associated with a higher incidence of motor response.