Objective To analyze the effectiveness and safety of different doses of remimazolam in elderly patients with combined spinal-epidural anesthesia．Methods From May 2020 to April 2023,126 elderly patients who needed combined spinal-epidural anesthesia in Wuxue First People's Hospital were included and randomly divided into low-dose group[42 cases,continuous infusion of 2 μg/（kg·min）reimazolam during operation],medium-dose group[42 cases,continuous infusion of 3 μg/（kg·min）reimazolam during operation],and high-dose group[42 cases,continuous infusion of 4 μg/（kg·min）reimazolam during operation]．The degree of sedation and vital signs were recorded at 5 minutes（T1）,15 minutes（T2）,and 30 minutes（T3）of administration,and the anesthesia effective time and block completion time were recorded,and the incidence of adverse reactions such as nausea,vomiting,and hypotension after anesthesia administration were recorded．Results The Ramsay scores at T1,T2 and T3 of the three groups were significantly higher than those at T0（P<0.05）．The Ramsay scores of the middle-dose group and high-dose group were significantly higher than those of the low-dose group at T2 and T3（P<0.05）．The Ramsay scores of the high-dose group were significantly higher than those of the middle-dose group at T2 and T3（P<0.05）．The mean arterial pressure and heart rate of the low-dose group and the middle-dose group at T2 and T3 were higher than those of the high-dose group（P<0.05）．The effective time of anesthesia and block completion time in the high-dose group and the middle-dose group were significantly shorter than those in the low-dose group（P<0.05）．The total incidences of adverse reactions such as hypoxemia and hypotension in the low-dose group and the middle-dose group were significantly lower than those in the high-dose group（P<α,α=0.017）．Conclusions The effect of 3 μg/（kg·min）remimazolam in elderly patients with spinal-epidural combined anesthesia is ideal,its analgesic effect is better than 2 μg/（kg·min）,the impact on vital signs is less than 4 μg/（kg·min）,with fewer adverse reactions,which is a balance between the sedative effect and the safety of anesthesia．