Objective To explore the effect of combined infusion of remifentanil and propofol at different concentrations on general anesthesia and recovery quality in patients undergoing laparoscopic hysterectomy based on patient state index (PSI) monitoring, and to investigate the optimal compatibility program of propofol and remifentanil. Methods A total of 184 patients who were scheduled for laparoscopic hysterectomy were selected. The study was divided into two parts. In part 1, the effect‑site concentration of propofol was calculated by the Probit method. According to the random number table method, the 64 patients were divided into three groups: a remifentanil 2 μg/L group (group Rl, n=20), a remifentanil 4 μg/L group (group Rm, n=23) and a remifentanil 6 μg/L group (group Rh, n=21). Their values of propofol effective concentration (EC50), 95% effective concentration (EC95) and their 95% confidence interval (95%CI) were calculated. In part 2, 120 patients were enrolled. According to different effect‑site concentration compatibility programs of propofol and remifentanil, they were divided into three groups using the random number table method (n=40): a remifentanil 2 μg/L+propofol 3.9 mg/L group (group Rl+Ph), a remifentanil 4 μg/L+propofol 3.4 mg/L group (group Rm+Pm), and a remifentanil 6 μg/L+propofol 2.7 mg/L group (group Rh+Pl). The adverse hemodynamic events, the duration of operation, recovery time, extubation time, the length of post‑anesthesia care unit (PACU) stay time and the duration of surgery were recorded. Then, the Visual Analogue Scale (VAS) scores were also recorded 15 min, 30 min, 1 h, and 24 h after extubation. Besides, the pressure of analgesic pump, the consumption of rescue analgesics within 24 h after extubation, and the incidence of nausea and vomiting, postoperative agitation within 24 h after surgery and intraoperative awareness were recorded. The patients in the three groups were further divided into group morning (8:00‒12:00, n=64) and group afternoon (12:00‒18:00, n=49) according to the operation time, recorded recovery time, extubation time and PACU stay time. Results For patients in the three groups, the EC50 value of remifentanil and its 95%CI were 3.0 (2.52‒3.79), 2.4 (1.86‒3.11) mg/L and 2.1 (1.63‒2.42) mg/L, while the EC95 value of remifentanil and its 95%CI were 3.9 (2.44‒8.79), 3.4 (2.86‒8.59) mg/L and 2.7 (2.35‒5.22) mg/L. Compared with group Rl+Ph and group Rm+Pm, the recovery time, extubation time, and the length of PACU stay were shortened in group Rh+Pl (P<0.05); the length of PACU stay in the Rl+Ph group was longer than that in the Rm+Pm group (P<0.05). There was no statistical difference in adverse hemodynamic events (bradycardia, tachycardia, hypertension, and hypotension) among the three groups (P>0.05). There was no statistical difference in VAS score among the three groups 15 min, 30 min, 1 h after extubation and 24 h after operation (P>0.05). There was no case of analgesic pump pressing and rescue analgesics use in the three groups. There was no statistical difference in the incidence of nausea and vomiting, and postoperative agitation among the three groups (P>0.05). Retrospective investigation of the three groups showed that there was no intraoperative awareness. There was no statistical difference in recovery time, extubation time and PACU stay time between group morning and group afternoon (P>0.05). Conclusions Under the guidance of PSI, the combined infusion of remifentanil has an effect‑site concentration of 6 μg/L and propofol with an effect‑site concentration of 2.7 mg/L, which can maintain a good anesthetic effect, and is conducive to reduce the time of awakening and extubation, and shorten the length of PACU stay.