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This study aims to compare the anesthetic effects of remimazolam tosilate and propofol in patients undergoing radical mastectomy. The study group received remimazolam tosilate in combination with sufentanil and cisatracurium besilate for anesthesia induction, while the control group received propofol with sufentanil and cisatracurium besilate. In the study group, the eyelash reflex disappearance time was longer and the recovery time was shorter compared to the control group (p < 0.05). No significant differences were observed in Post-Anesthesia Care Unit (PACU) retention time and Visual Analogue Scale (VAS) scores at 24 hours post-operation between the groups (p > 0.05). Furthermore, the study group exhibited a lower decrease in Mean Arterial Pressure (MAP) at 1, 3 and 5 minutes after anesthesia induction (p<0.05). After losing consciousness, there was no statistically significant difference in HR decrease between both groups (p > 0.05). The study group also had higher respiratory rate (RR) and Tidal volume (VT) levels, with a lower incidence of apnea compared to the control group (p < 0.05). Thirty minutes before anesthesia, no significant differences were found in the five indicators between the groups (p>0.05). At 24 hours post-operation, the study group showed higher Cluster of Differentiation 3+ (CD3+), CD4+, natural killer (NK) cell levels and CD4+/CD8+ ratios compared to the control group (p < 0.05). However, at 72 hours post-operation, no statistically significant differences were observed in these five indicators between the groups (p > 0.05). Compared with propofol, remimazolam tosilate achieves rapid sedation, maintains adequate sedation, and reduces suppression of the respiratory and circulatory systems. [ABSTRACT FROM AUTHOR]