Objective To evaluate the effect of remimazolam combined with propofol on painless abortion. Methods A total of 210 patients who were scheduled for painless abortion were enrolled. According to the random number table method, they were divided into three groups (n=70): a remimazolam group (group R), a propofol group (group P) and a remimazolam combined with propofol group (group RP). Group R was administered with 0.2 mg/kg remimazolam, and group P was given 2 mg/kg propofol, while group RP received 0.1 mg/kg remimazolam plus 1.0 mg/kg propofol. During operation, 0.05 mg/kg remimazolam was added to group R and 0.5 mg/kg propofol to group P and group RP if necessary. Then, their mean arterial pressure (MAP), heart rate and pulse oxygen saturation (SpO2) were recorded before anesthesia (T0), 1.5 min after induction (T1), 3.5 min after induction (T2), and at the end of surgery (T3). The onset time of anesthesia, time for emergence from anesthesia, and adverse reactions (intraoperative motor responses, injection pain, hypotension, respiratory inhibition, postoperative nausea and vomiting, intraoperative awareness, and allergy) were recorded. The Positive and Negative Affect Scale (PANAS) was used to evaluate the patients' positive and negative emotions 15 min before surgery and 45 min after surgery. Results Compared with group R, the time for emergence from anesthesia was reduced in group P and group RP (P<0.05), and there was no statistical difference in the onset time of anesthesia among the three groups (P>0.05). At T1, group R and group RP showed higher MAP, heart rate and SpO2 than group P (P<0.05), but no statistical differences were found in MAP, heart rate and SpO2 at T0, T2 and T3 (P>0.05). Compared with group P, the incidences of hypotension, respiratory inhabitation and injection pain were reduced in group R and group RP (P<0.05). Group R presented a higher incidence of intraoperative motor response than group P and group RP (P<0.05). There were no statistical differences as to the incidences of intraoperative awareness, allergy, nausea and vomiting among the three groups (P>0.05). Furthermore, all the three groups showed lower postoperative negative emotion than that before surgery (P<0.05), and higher postoperative positive emotion than that before surgery (P<0.05). Group RP showed higher postoperative positive emotion than group R and group P (P<0.05). Conclusions Remimazolam combined with propofol is safe and effective in painless abortion, with superior anesthetic effect to propofol or remimazolam alone, and characterized by a low incidence of intravenous pain, little hemodynamic effect, and increased postoperative positive emotion.