Objective To investigate the clinical effect of dyclonine combined with propofol in the painless gastroscopy in elderly patients. Methods A total of 150 elderly patients who received the painless gastroscopy in the Second Affiliated Hospital of Xinjiang Medical University were enrolled from Jul 2020 to Mar 2021. All of the patients were divided into three groups according to the random number table method (n=50): propofol group (P group), fentanyl+propofol group (FP group), and dyclonine+propofol group (DP group). The patients in DP group took 10 ml of dyclonine mucilage orally 10 min before the examination, and swallowed it slowly after 2 min in throat. The patients in FP group were injected with fentanyl 1 μg/kg intravenously 3 min before the examination. The three groups had 1.5 mg/kg propofol intravenous anesthesia.The general condition and gastroscopy examination time were recorded. The mean arterial pressure (MAP), heart rate, and SpO2 were recorded at the time point T1 (before dosing), T2 (gastroscope reaches the cardia), T3 (gastroscope pulled out). This article also recorded the side effects (the occurrence of choking cough, body movement, hiccup, respiratory depression), the propofol consumption, the awakening time, scores of operator satisfaction. Results Compared with those at T1 time, the MAP、 SpO2、heart rate of patients in the P group and FP group were decreased at T2 (P<0.05). Compared with those at T2, the MAP、 SpO2、heart rate of patients in the P group and FP group are increased at T3 (P<0.05). The MAP, heart rate, SpO2 in the DP group were higher than those in the P group and FP group at T2 (P<0.05). Compared with the P group and FP group, the incidence of body movement and respiratory depression, the awakening time in the DP group was decreased (P<0.05), the scores of operator satisfaction in DP group were higher (P<0.05). The propofol consumption in DP and FP group were lower than those in P group (P<0.05). There was no significant difference in other indicators (P>0.05). Conclusions Dyclonine combined with propofol in elderly patients can maintain the stability of hemodynamics, reduce the incidence of side effects and propofol consumption, and shorten the time of recovery. Therefore, it is safe and feasible anesthesia management for elderly patients in painless gastroscopy.