Objective: To analyze the application value of remazolam compound alfentanil anesthesia regimen in fiberoptic bronchoscopy in elderly debilitated patients. Methods: Seventy-two cases of elderly debilitated patients who underwent fiberoptic bronchoscopy in the Department of Respiratory Medicine of a hospital from August 2023 to July 2024 were selected, and were divided into the control group and the observation group using the mean score method, with 36 cases in each group. In both groups, 7–10 μg/kg alfentanil was injected intravenously after oxygen denitrification, and 1 min later propofol 1.5 mg/kg was given intravenously in the control group and remazolam 0.3 mg/kg was given intravenously in the observation group. Subsequently, mivacurium chloride 0.1mg/kg IV was given to both groups. Propofol 5mg/(kg-h) was given in the control group and remazolam 0.5mg/(kg-h) was given intravenously pumped in the observation group during anesthesia maintenance. Changes in vital signs such as HR, MAP and SpO₂ and the occurrence of adverse reactions were recorded in the two groups before anesthesia administration (T₁), at the moment of placing fiberoptic bronchoscope (T₂), at the moment of placing the tracheal tube (T₃), and at 1 min after placing the tracheal tube (T₄). Results: Compared with T₁, patients in the observation group had lower MAP at T₂, T₃, T₄ and lower SpO₂ at T₃, T₄ (P < 0.05); in the control group, HR slowed down at T₂, T₃, T₄ and MAP and SpO₂ decreased at T₂, T₃, T₄ (P < 0.05). SpO₂ at T₃ and T₄ was lower in both groups compared with that at T₂ (P < 0.05). SpO₂ at T₄ was lower in the control group compared with that at T₃ (P < 0.05). Compared with the control group, patients in the observation group suffered from increased HR and elevated MAP at T₂, T₃, and T₄, and increased SpO₂ at T₃ and T₄ (P < 0.05). The incidence of intraoperative hypotension and bradycardia in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05). The incidence of intraoperative choking and coughing, postoperative hypoxemia, nausea and vomiting, and dizziness were found in the patients of both groups, drowsiness and other adverse reactions incidence rate comparison, the difference are not statistically significant (P > 0.05). Conclusion: Remazolam and alfentanil are used in fiberoptic bronchoscopy for elderly debilitated patients with remarkable effect, which can effectively improve the vital signs of patients, reduce the risk of intraoperative hypotension, bradycardia, and other adverse reactions, and have high anesthetic effectiveness and safety.