Objective To investigate the anesthetic eff ect of remifentanil tosylate on elderly patients under- going endoscopic retrograde cholangiopancreatography. Method Eighty elderly patients undergoing endoscopic retrograde cholangiopancreatography admitted to Shuyang Mercy Hospital in Suqian City from January 2021 to June 2024 were randomly divided into two groups using a random number table. The control group (n=40) received combined anesthesia with propofol and sufentanil, while the observation group (n=40) received combined anesthe-sia with remifentanil and sufentanil. Compare surgical related indicators, hemodynamic parameters at diff erent time points, levels of infl ammatory factors before and after surgery, pain scores, quality of life scores, and incidence of adverse events between two groups of patients. Result There was no signifi cant diff erence in surgical time, intra-operative blood loss, and complete stone clearance rate between the two groups of patients (P > 0.05), but the observation group had fewer body movements during surgery and shorter postoperative recovery time than the control group, with signifi cant diff erences (P < 0.001). There was no signifi cant diff erence (P > 0.05) in heart rate, mean arterial pressure, and blood oxygen saturation between the two groups of patients before anesthesia and when awake after surgery. At the time of insertion and 10 minutes after insertion, the heart rate, mean arterial pressure, and blood oxygen saturation of the observation group were signifi cantly higher than those of the control group (P < 0.05). Before surgery, there was no signifi cant diff erence in the levels of infl ammatory factors, pain scores, and quality of life scores between the two groups of patients (P > 0.05). After surgery, the levels of tumor necrosis factor-α and interleukin-6 in the observation group were lower than those in the control group, the pain score was lower than that in the control group, and the quality of life score was higher than that in the control group, with signifi cant diff er-ences (P < 0.001). The incidence of adverse reactions in the observation group was signifi cantly lower than that in
the control group (5.00% vs. 25.00%; χ2=6.275, P=0.012). Conclusion The use of remifentanil tosylate anesthesia in elderly patients undergoing endoscopic retrograde cholangiopancreatography can improve anesthesia eff ective-ness, reduce postoperative pain, improve quality of life, and increase safety.