The case concerns a patient with obesity, obstructive sleep apnea syndrome, and airway difficulties who was at high risk for hypoxemia and deep sedation complications.[1][3] An initial attempt at gastroscopy was aborted due to propofol-induced respiratory complications, including significant coughing and severe hypoxemia.[1] The optimized anesthetic protocol included proactive establishment of upper airway patency using a lubricated nasopharyngeal conduit and careful induction of sedation using remimazolam, an ultrashort-acting benzodiazepine.[1] Remimazolam was chosen for its superior cardiorespiratory stability compared to other sedatives.[1] This strategy successfully maintained spontaneous ventilation and stable hemodynamics throughout the entire gastroscopy procedure.[1] Sedation could be immediately reversed with flumazenil, allowing rapid postoperative recovery.[1] The case demonstrates that the combination of remimazolam with a nasopharyngeal airway is a safe and effective option for high-risk patients with obesity and airway difficulties.