Objective To explore the effect of propofol combined with remifentanil anesthesia in patients undergoing hysteroscopic myomectomy. Methods 79 patients who underwent hysteroscopic myomectomy in our hospital from April 2022 to April 2024 were selected as the study objects. The patients were divided into control group and study group by random number table, with 38 cases in each group. The control group was anesthetized with propofol combined with fentanyl; The study group underwent combined anesthesia with propofol and remifentanil. The operative conditions (onset time of anesthesia, dosage of propofol, recovery time and orientation recovery time), Heart Rate (HR) and mean arterial pressure (MAP), sedation effect (Ramsay sedation score), and adverse reactions of the two groups were analyzed and compared.? Results The onset time of anesthesia, the dosage of propofol, the recovery time and the recovery time of orientation in the study group were significantly lower than those in the control group (P < 0.05). After anesthesia, HR and MAP in both groups decreased first and then increased, and there was no significant difference in HR and MAP levels between the two groups at t0, t1 and t3 periods (P > 0.05), while HR and MAP in the study group at t2 period were significantly lower than those in the control group (P < 0.05). The rate of good sedation in the study group was significantly higher than that in the control group (P < 0.05). The incidence of adverse reactions in study group was significantly lower than that in control group (P < 0.05). Conclusion The anesthesia of propofol combined with remifentanil can improve the operative conditions, maintain the stability of the vital signs of the patients undergoing hysteroscopic myomectomy, improve the sedation effect, shorten the recovery time, and have a high safety.