AIM: To evaluate the feasibility of Marsh target-controlled infusion of simulated propofol with remimazolam for induction and maintenance of anesthesia in patients undergoing laparoscopic gallbladder surgery. METHODS: A total of 80 patients undergoing elective laparoscopic gallbladder surgery were randomly divided into propofol group (Group P) and remimazolam group (Group R), with 40 cases in each group. Anesthesia was induced and maintained by target-controlled infusion of propofol and remimazolam respectively (Marsh mode, plasma target concentration). The time of loss of consciousness was recorded, and HR, MAP and BIS were induced before intubation (T0), immediately after intubation (T1), 3min after intubation (T2), immediately after pneumoperitoneum (T3), 30min during surgery (T4), and after surgery (T5). Injection pain, tracheal extubation time and postoperative adverse reactions were recorded. RESULTS: Compared with Group P, the loss of consciousness in Group R was shorter (P<0.05), the incidence of injection pain, intraoperative hypotension and bradycardia was lower (P<0.05), but the postoperative extubation time was longer (P<0.05). CONCLUSION: Remimazolam can be applied to the Marsh mode of propofol, and Remimazolam mimic target-controlled infusion (Marsh mode) has a good effect and safety on inducing and maintaining sedation under general anesthesia,as well as the vital signs are stable.