The study compared the effects of remimazolam and sevoflurane on postoperative delirium (POD) and early cognitive impairment in 90 elderly patients after laparoscopic gastrointestinal surgery. Patients were randomly divided into three groups (n=30): remimazolam (R), sevoflurane (S) and combination group (RS). No significant differences were found in POD incidence (p=0.654), time of occurrence (p=0.985), duration (p=0.355) or classification (p=1.00) between groups. The incidence of delayed cognitive recovery was also not different (p=0.616). In group R, there was a lower incidence of intraoperative hypotension and less use of vasoactive drugs (p<0.05). When combined with sevoflurane, the induction and maintenance doses of remimazolam were reduced and the time to loss of consciousness was shortened (p<0.05). Remimazolam was not associated with increased POD or delayed recovery of cognitive function and had less effect on the circulation than sevoflurane. The study is registered under ChiCRT2200064984.