Objective:To explore the application effect of remazolam besylate in elderly hip fracture surgery and its impact on anesthesia recovery quality and bone metabolism indicators.Methods:A total of 100 elderly patients with hip fractures admitted to Ningde Hospital from January 2021 to April 2022 were selected, all of whom underwent hip replacement surgery. According to the random number table method, they were divided into an observation group ( n=50) and a control group ( n=50). We observed the use of drugs such as remifentanil besylate combined with sufentanil for anesthesia induction and remifentanil combined with other drugs for anesthesia maintenance; The control group received anesthesia induction with drugs such as midazolam combined with sufentanil, and anesthesia maintenance with drugs such as remifentanil. Comparisons were made between the analgesic effects of anesthesia, the quality of anesthesia recovery, and the levels of hemodynamic and bone metabolism indicators at different time points between the two groups. Results:The postoperative recovery time, eye opening time, and extubation time of the observation group were shorter than those of the control group (all P<0.05); The total incidence of restlessness and coughing was lower in the control group than in the control group ( P<0.05); There was no statistically significant difference in the levels of serum osteocalcin (BGP), parathyroid hormone (PTH), and bone alkaline phosphatase (BALP) between the two groups after treatment (all P>0.05); The heart rate (HR) and mean arterial pressure (MAP) of the observation group during skin cutting (T 2) and 5 minutes after extubation (T 3) were lower than those of the control group (all P<0.05), and SpO 2 was higher than that of the control group ( P<0.05). The excellent rate of anesthesia and analgesic effect in the observation group was significantly higher than that in the control group ( P<0.05). Conclusions:Remazolam besylate has a good clinical effect in hip surgery, and the quality of anesthesia recovery is relatively high, but it has little effect on the postoperative bone metabolism indicators.