Abstract: Objective The aim of this study was to investigate anesthetic efficacy of remimazolam and ciprofol combination in patients with intrahepatic bile duct stones (IHBDS) undergoing laparoscopic partial hepatectomy (LPH). Methods 119 patients with IHBDS were encountered in our hospital between December 2023 and June 2025, and all underwent LPH for resection of intrahepatic tumors. Patients were randomly divided into two groups, receiving ciprofol (group C, n=60) or remimazolam and ciprofol combination (group RC, n=59) intravenous anesthesia. Serum cortisol (Cor), adrenocorticotropic hormone (ACTH) and norepinephrine (NE) levels were measured by ELISA, and peripheral blood CD3⁺, CD4⁺ and CD8⁺ cell percentages were detected by flow cytometry, and CD4⁺/CD8⁺ cell ratio was calculated. The cognitive function was evaluated by mini-mental state examination (MMSE). Results By end of three days after operation, serum Cor, ACTH and NE levels in group RC were (240.9±42.6)mmol/L, (19.3±3.9)pmol/L and (2.8±0.6)pg/mL, all significantly lower than [(288.2±55.7) mmol/L, (24.4±5.3) pmol/L and (3.4±0.7)pg/mL, respectively, P<0.05] in group C; MMSE score in group RC was (28.6±1.9), not significantly different as compared to [(28.0±1.6), P>0.05] in group C; percentages of peripheral blood CD3⁺, CD4⁺ and CD8⁺ cells, and CD4⁺/CD8⁺ cell ratio in group RC were (68.2±8.7)%, (42.0±8.3)%, (23.7±5.9)%, and (1.9±0.7), all not significantly different compared to [(66.9±9.1)%,(40.4±7.8)%,(24.3±6.1)%, and (1.8±0.7), P>0.05] in group C; incidence of hypotension during operation in group RC was 8.5%,much lower than 21.7%(P<0.05) in group C,while there was no significant difference as respect to total incidence of complications (22.0% vs. 36.7%)between the two groups(P>0.05). Conclusion Application of remimazolam in combination with ciprofol anesthesia could effectively inhibit body stress reactions in patients with undergoing LPH, which don’t impact postoperative cognitive functions.

Key words: Intrahepatic bile duct stones, Laparoscopic partial hepatectomy, Remimazolam, Ciprofol, Stress response, Cognition, Anesthesia