Objective To investigate the effect of remimazolam besylate on the recovery of psychomotor function in patients undergoing painless gastrointestinal endoscopy. Methods A total of 120 patients, ASA Ⅰ or Ⅱ, aged 18−70 years, who were scheduled for painless gastrointestinal endoscopy, were selected. According to the random number table method, they were divided into three groups (n=40): a propofol group (group P), a remimazolam besylate group (group R) and a remimazolam besylate combined with propofol group (group S). Then, the patients were intravenously injected with remifentanil at 0.2 μg/kg for anesthesia induction. Patients in group P were intravenously injected with propofol at 1.0−2.0 mg/kg, group R was intravenously injected with remimazolam besylate at 0.2 mg/kg and those in group S was intravenously injected with 7 mg remimazolam besylate combined with 0.5 mg/kg propofol. The psychomotor function test was performed after the recovery of orientation. ① The Romberg test was used to evaluate and record the number of patients who could sit up independently 5 min after regaining orientation and stand stably 10 min after regaining orientation. ② Then, 15 min after the patients regained orientation, the finger tapping test, choice reaction time (CRT) test, digit‑symbol substitution test (DSST) and number connection test‑A (NCT‑A) were conducted successively, and each test was carried out once every 5 min until the results returned to the baseline. The recovery time of each indicator was recorded. The time of examination, recovery and discharge, as well as adverse reactions (respiratory depression, hypotension) and the number of patients who added drugs for more than 3 times were recorded. Results Group R and group S showed shorter recovery time of the finger tapping test, CRT, DSST and NCT‑A than group P (P<0.05). Compared with group R, group S presented decreases in the recovery time of CRT, DSST and NCT‑A (P<0.05) and increases in the recovery time of the finger tapping test (P<0.05). The number of patients who could sit up independently 5 min after regaining orientation and stand stably 10 min after regaining orientation were more than that in group P and group R (P<0.05). Compared with group P, the recovery time was prolonged and the discharge time was shortened in group R (P<0.05), while the time of recovery and discharge was shortened in group S (P<0.05). Compared with group R, group S showed reduced recovery time (P<0.05), without statistical difference in discharge time (P>0.05). Compared with group P, the incidence of respiratory depression and hypotension decreased in group R and group S (P<0.05), compared with group R, the number of patients who added drugs more than three times decreased in group S and group P (P<0.05). Conclusions When remimazolam besylate was applied for painless gastrointestinal endoscopy, patients show a slightly faster recovery rate of psychomotor function than those treated with propofol, but the combined use of remimazolam besylate and propofol results in the fastest psychomotor recovery rate of was the fastest.