Objective: To analyze the influences of sevoflurane combined with propofol and remifentanil anesthesia on hemodynamic indexes and postoperative delirium in elderly patients with coronary heart disease (CHD) undergoing laparoscopic surgery. Methods: One hundred and twenty elderly CHD patients who underwent laparoscopic gastrointestinal surgery in Jincheng People’s Hospital from January 2020 to December 2020 were selected as the research subjects. The patients were randomly divided into the study group (60 cases) and the control group (60 cases), sevoflurane inhalation combined with propofol and remifentanil intravenous drip was used for anesthesia maintenance in the study group, and propofol and remifentanil intravenous drip was used for anesthesia maintenance in the control group. The mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), left ventricular work (LCW) and blood oxygen saturation (SpO₂) were monitored at the time points of before anesthesia induction (T0), during endotracheal intubation (T1), 10 min after pneumoperitoneum establishment (T2) and extubation (T3). The incidences of perioperative cardiovascular events, the application of vasoactive drugs, the recovery indexes and the incidence of postoperative delirium were compared between the two groups. Results: At T1, T2 and T3 time points, the levels of MAP, CO, CI, SVR and LCW in the study group were higher than those in the control group (P<0.05), and the level of HR was lower than that in the control group (P<0.05). The incidence of perioperative myocardial ischemia and the proportion of application of nitroglycerin and esmolol in the study group were lower than those in the control group (P<0.05). The recovery time of spontaneous breathing, the time of extubation, the time for eye opening, the time for speech response, the time for directional force recovery in the study group were shorter than those in the control group (P<0.05). The incidence of postoperative delirium was lower than that in the control group (P<0.05). Conclusion: In the laparoscopic gastrointestinal surgery for elderly patients with CHD, the anesthesia scheme of sevoflurane combined with propofol and remifentanil is better than propofol and remifentanil intravenous anesthesia in stabilizing hemodynamic indexes, protecting cardiac function, accelerating postoperative rehabilitation and reducing postoperative delirium.