Objective To evaluate the safety and efficacy of ramazolam toluenesulfonic acid in painless gastrointestinal endoscopy for elderly patients and its effect on early cognitive function. Methods A total of 208 patients aged over 60 years scheduled for painless gastrointestinal endoscopy were randomly divided into 2 groups， 104 in each group. For anesthesia，the patients in the ramazolam group were treated with ramazolam and sufentanil and those in the propofol group with propofol and sufentanil. The vital indices such as mean arterial pressure （MAP），heart rate（HR），respiratory frequency（RR）and blood oxygen saturation（SpO2）were recorded at different times after entering the endoscopy room. The side effects such as hypotension，hypoxemia，body movement，nausea， severe sinus bradycardia and vomiting ，dizzy and drowsiness were also recorded. The degree of postoperative abdominal pain and cognitive function were recorded with NRS questionnaire and MMSE questionnaire. Results The sedative effects，postoperative cognitive function and physician satisfaction in the ramazolam group were better than in the propofol group. Furthermore，the induction time，number of body movements，recovery time and side effects in the ramazolam group were all lower than in the propofol group. There was no significant difference in the time of endoscopic operation and patients′ satisfaction（P > 0.05）. Conclusion Ramazolam toluenesulfonic acid can is safe for anesthesia in the painless gastrointestinal endoscopy for elderly patients，and it can prevent postoper⁃ ative cognitive impairment.