Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 24 1 2025 01 14 41 51 Jianyan Wu School of Anesthesiology, Shandong Second Medical University, Weifang, China AND Affiliated Hospital of Shandong Second Medical University, Weifang, China AND Jiaozhou Hospital, East Hospital Affiliated to Tongji University, Qingdao, China Huijie Ma School of Anesthesiology, Shandong Second Medical University, Weifang, China AND Affiliated Hospital of Shandong Second Medical University, Weifang, China Boya Zhang School of Anesthesiology, Shandong Second Medical University, Weifang, China AND Affiliated Hospital of Shandong Second Medical University, Weifang, China Ying Wang School of Anesthesiology, Shandong Second Medical University, Weifang, China AND Affiliated Hospital of Shandong Second Medical University, Weifang, China Yingui Sun School of Anesthesiology, Shandong Second Medical University, Weifang, China AND Affiliated Hospital of Shandong Second Medical University, Weifang, China 2024 10 24 2024 12 01 We aimed to evaluate the effect of remimazolam-based general anesthesia on cellular immune function and postoperative recovery quality in patients undergoing laparoscopic radical colorectal cancer surgery. A total of 90 patients scheduled for elective laparoscopic colorectal cancer radical surgery were randomly divided into 2 groups: the remimazolam group (Group R) and the propofol group (Group P), with 45 patients in each group. Anesthesia induction in Group R involved intravenous remimazolam, and in Group P, intravenous propofol until the loss of consciousness (modified observer’s assessment of alertness/sedation [MOAA/S] score 1–2). Both groups then received intravenous sufentanil and cisatracurium for intubation. Cellular immune function markers (CD3+, CD4+, CD8+ T and natural killer [NK] cells) were recorded at different time points. Quality of Recovery [QoR]-15 scale scores, hemodynamic parameters, sedation scores (Riker and Ramsay scales), recovery times and adverse events were also recorded. Compared to Group P, Group R had significantly higher NK, CD3+, and CD4+ cell levels immediately after surgery and at 24 hours postoperatively. Group R showed a significantly lower incidence of intraoperative hypotension, bradycardia, and vasopressor use. Additionally, QoR-15 scores at 24 and 72 hours were higher in Group R. There were no significant differences in Riker or Ramsay scores, extubation time, post-anesthesia care unit stay, or the incidence of postoperative nausea, vomiting, and drowsiness between the 2 groups. Compared with propofol, remimazolam anesthesia results in better perioperative immune function preservation, reduced intraoperative hypotension and bradycardia, and improved postoperative recovery quality in patients undergoing laparoscopic radical colorectal cancer surgery. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/4228 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/4228/2155