Objective To investigate the effects of remimazolam fast⁃track anesthesia on intraoperative hemodynamics and postoperative recovery in patients receiving cardiac valve surgery. Methods A total of 102 patients receiving cardiac valve surgery were enrolled as the research subjects, and they were randomly divided into control group or observation group, with 51 cases in each group. Combined anesthesia mainly containing propofol, and fast⁃track anesthesia based on remimazolam were given to the two groups, respectively. Hemodynamic parameters, myocardial injury biomarkers, early recovery variables, neurological function recovery indicators, postoperative recovery quality, and the occurrence status of postoperative complications were compared between the two groups. Results Heart rate, mean arterial pressure (MAP), and total scores of Quality of Recovery 15 (QoR⁃15) scale in both groups exhibited a trend of initial decrease followed by an increase over time (P<0.05). After anesthesia induction, MAP was higher in the observation group than in the control group (P<0.05). After tracheal intubation, heart rate was lower and MAP was higher in the observation group than in the control group (P<0.05). Five minutes after the beginning of surgery, the observation group yielded a lower heart rate and MAP as compared with the control group (P<0.05). One day before discharge, the total QoR⁃15 scale score was higher in the observation group than in the control group (P<0.05). At 24 hours postoperatively, serum levels of cardiac troponin I , creatine kinase⁃MB, and heart⁃type fatty acid⁃binding protein were elevated compared with pre⁃anesthesia levels in both groups, and these biomarkers were lower in the observation group than in the control group (P<0.05). There was no statistically significant difference in mechanical ventilation duration between the two groups (P>0.05). However, the length of ICU stay, postoperative length of hospital stay, time to orientation recovery, time to spontaneous breathing recovery, and time to postoperative tracheal extubation were all shorter in the observation group than in the control group (P<0.05). The incidence rate of postoperative complications interpreted no statistically significant difference between the two groups (P>0.05). Conclusion Remimazolam fast⁃track anesthesia stabilizes intraoperative hemodynamics, promotes postoperative recovery, and attenuates myocardial injury in patients undergoing cardiac valve surgery, with a favorable safety profile.

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