【Abstract】 Objective To investigate the clinical application of remimazolam tosylate in patients undergoing intracranial aneurysm embolization surgery. Methods Seventy patients of both sexes, aged 20‒60 y, with body mass index (BMI) 18‒28 kg/m2, American Society of Anesthesiologists (ASA) physical status Ⅰ‒Ⅲ, scheduled for intracranial aneurysm embolization surgery, were divided into two groups using a random number table method (n=35): remimazolam tosylate (group R) and propofol (group P). Propofol 2 mg/kg was given intravenously in group P, and remimazolam tosylate 0.3 mg/kg was given intravenously in group R during anesthesia induction. Alfentanil 10 μg/kg and micuronium chloride 0.2 mg/kg were given in both groups after the patients lost consciousness. After laryngeal mask placement, propofol 4‒8 mg·kg−1·h−1, remimazolam tosylate 0.3‒1.0 mg·kg−1·h−1 and remifentanil 0.1 μg·kg−1·min−1 and micuronium chloride 0.2 mg·kg−1·h−1 were injected by pump in group P and group R. Recorded blood pressure and heart rate, BIS values, and modified Observer's Assessment of Alert/Sedation (mOAA/S) before anesthesia induction (T0), when placing a laryngeal mask (T1), fiber bronchoscope arrived at juga (T2), surgery begin to 10 min (T3), at the end of surgery (T4) and at the time point of the patient wake‑up (T5). The time from the start of anesthesia to the withdrawal of anesthesia (anesthesia time), the time from the beginning of surgery to the end of surgery (operation time), and the time from the end of administration to recovery (recovery time), and the time from the end of administration to the removal of laryngeal mask (extubation time) were recorded. The intraoperative and postoperative adverse events or reactions were recorded, such as bradycardia, hypotension, injection pain, dizziness, and drowsiness. The intraoperative awareness was recorded using the Brice questionnaire method. Results Compared with T0, in group P, there was a decreased significantly in heart rate at T1, T2, and T3 (P<0.05), systolic blood pressure (SBP) decreased significantly at T1, T2, T3, and T4 (P<0.05), and diastolic blood pressure (DBP) decreased significantly at T1, T2, and T3 (P<0.05). BIS decreased significantly at T1, T2, T3, T4 and T5 (P<0.05); in group R, heart rate decreased significantly at T3 (P<0.05), SBP decreased significantly at T1, T2, T3, and T4 (P<0.05)， and DBP decreased significantly at T1, T2 and T3 (P<0.05)， BIS decreased substantially at T1, T2, T3, T4, T5 (P<0.05). Compared with group P, DBP increased in group R at T2 (P<0.05), and heart rate increased at T1, T2, and T4 (P<0.05), BIS rose at T1, T2, T3, and T5 (P<0.05). There was no difference in mOAA/S score between the two groups at each time point (P>0.05), and there was no significant difference in anesthesia time and operation time between the two groups （P>0.05). Compared with group P, the wake‑up time was shortened in group R, and the extubation time was shortened in group R (P<0.05). Compared with group P, group R had no injection pain and a lower overall incidence of adverse reactions (P<0.05). There was no significant difference in the incidence of intraoperative hypotension, remedial sedation, dizziness, drowsiness, and nausea between the two groups （P>0.05); and there were not bradycardia, hypertension and intraoperative awareness occurred in the two groups. Conclusions Rimazolam tosylate can be safely used for anesthesia during intracranial aneurysm embolization surgery, and there is no significant effect on heart rate when induced, and there is no injection pain.