Abstract:Objective To compare the differences in efficacy and safety between remimazolam tosylate and propofol for sedation during painless gastroscopy, and its effect on awakening time and discharge time. Methods A total of 80 patients scheduled for painless gastroscopy at Henan Provincial People’s Hospital from August 2023 to October 2024 were selected as the study subjects. According to a random number table, the patients were divided into a remimazolam group (n=40) and a propofol group (n=40). The sedation success rates were compared between the two groups. Mean arterial pressure (MAP), heart rate and end-tidal carbon dioxide partial pressure (PETCO2) were compared between the two groups at the following time points: upon entering the procedure room, during gastroscope insertion, during gastroscope withdrawal, and at the end of anesthesia. The incidence of adverse events (including swallowing movements and body movements during gastroscope insertion, as well as intraoperative respiratory depression, etc.) was recorded for both groups. The time from the end of the last drug administration to complete awakening and the time to discharge were recorded for both groups. Results There was no statistically significant difference in sedation success rate between the remimazolam group and the propofol group [92.5% (37/40) vs 87.5% (35/40), χ²=0.139, P=0.709]. In terms of MAP, heart rate and PETCO2 between the two groups, had statistically significant between-group effect, time effect, and between -group × time interaction effect (P<0.01). Moreover, the three indicators in the remimazolam group were better than those in the propofol group at gastroscope insertion, gastroscope withdrawal and the end of anesthesia (P<0.05). The total incidence of adverse reactions in the remimazolam group was 15.00% (6/40), and the difference was not statistically significant compared with 27.50% (11/40) in the propofol group (χ²=1.867, P=0.172). There was no statistically significant difference in recovery time between the remimazolam group and the propofol group [ (7.2±3.6) min vs (8.5±4.2) min, t=1.486, P=0.141]. The discharge time in the remimazolam group was earlier than that in the propofol group, and the difference was statistically significant [ (23.6 ± 5.7) min vs (27.4 ± 7.8) min, t=2.488, P=0.015]. Conclusion Remimazolam tosilate provides effective sedation with good safety when used for painless gastroscopy.