Objective To study the anesthetic effect of midazolam in general anesthesia gynecological surgery and its effect on patients’ cognitive function and stress response. Methods 102 patients who underwent general anesthesia gynecological surgery in our hospital from January 2021 to December 2022 were selected and randomly divided into propofol group and remazolam group, with 51 cases in each group. propofol group used propofol for anesthesia induction, intravenous infusion of remifentanil and propofol for anesthesia maintenance, remazolam group used midazolam for anesthesia induction, intravenous infusion of remifentanil and midazolam for anesthesia maintenance. The operation time and anesthetic effect of the two groups were compared. The perioperative hemodynamic indicators and stress indicators of the two groups were compared. The postoperative cognitive function and adverse reactions of the two groups were compared. Results The sedation success rate of both groups was 100%. The eyelash reflex disappearance time, NI value decreased to D0 time, and recovery time of propofol group and remazolam group were compared by t-test, and the differences were statistically significant (t=14.986, P=0.000; t=10.774, P=0.000; t=3.895，P=0.000), eyelash reflex disappearance time, NI value decreased to D0 time of propofol group were shorter than those of remazolam group, recovery time was longer than that of remazolam group. The mean arterial pressure (MAP) at 30 min after the start of surgery and at the end of surgery in propofol group and remazolam group were compared by t-test, and the differences were statistically significant (t=3.006, P=0.003; t=2.338, P=0.021), which of propofol group was lower than that of remazolam group. The serum adrenocorticotropic hormone (ACTH) and aldosterone (ALD) levels before surgery, at the end of surgery, and 48 h after surgery in propofol group and remazolam group were compared by t-test, and the difference was not statistically significant (P>0.05). The incidence of postoperative cognitive dysfunction, injection pain, and respiratory depression in propofol group and remazolam group were compared by Fisher’s exact test, and the differences were statistically significant (P=0.028, 0.027, 0.028), which of propofol group was higher than those of remazolam group. Conclusion Compared with propofol, Remazolam has a slower effect in gynecological surgery under general anesthesia, but has less impact on hemodynamics and cognitive function, and has higher safety. The two effects are similar in anesthetic effect and stress response.