Objective To investigate the effects of sevoflurane anesthesia on the hemodynamics, plasma cortisol (Cor), atrial natriuretic peptide (ANP) and serum ,epinephrine (E), norepinephrine (NE) levels in elderly patients with cholecystolithiasis treated with laparoscopic surgery. Methods A total of 60 elderly patients with cholecystolithiasis treated with laparoscopic surgery admitted to the Danyang Hospital of Traditional Chinese Medicine from January 2020 to December 2020 were selected and acted as the research subjects, and they were divided into the control group and the research group according to the random number table method, with 30 cases in each group. Patients in the both groups were treated with laparoscopic surgery, and patients in the control group received propofol and remifentanil for anesthesia maintenance, and patients in the research group received sevoflurane and remifentanil for anesthesia maintenance. the anesthesia-related indicators of patients were compared between the two groups; and the changes of the mean arterial pressure (MAP), heart rate (HR) levels before anesthesia, 20 min after anesthesia, 10 min after the surgery started, and immediately after surgery of patients in the two groups were compared; the levels of plasma Cor, ANP and serum E, NE, and mini-mental state scale (MMSE) scores before and 48 h after surgery, the observer assessment of sedation (OAAS) score after awakening and 30 min after awakening, the occurrence of adverse reactions within 48 h after surgery of patients in the two groups were compared. Results The recovery of spontaneous breathing time, the recovery of command movements time, the smooth response to speech time, and the extubation time of the patients in the research group were significantly shorter than those in the control group; compared with before anesthesia, the MAP level of patients in the control group decreased at first and then increased from 20 min after anesthesia to immediately after surgery, and the MAP levels of patients in the research group at each time point was significantly higherthan those in the control group; the HR levels of patients in the two groups increased first and then decreased, and the HR levels of patients in the research group at each time point was significantly lower than those in the control group (P<0.05); and the MAP level of patients in the research group from 20 min after anesthesia to immediately after surgery didn’t significantly changed, and the difference was not statistically significant (P>0.05), compared with before surgery, the levels of plasma Cor, ANP and serum E of patients in th two groups, and the NE level of patients in the control group 48 h after the surgery significantly increased, but the above indexes in the research group were significantly lower than those in the control group; the OAAS scores of the patients in the research group awakening and 30 min after awakening were significantly higher than those in the control group; compared with before surgery, the MMSE scores of patients in the two groups at 48 h after surgery significantly decreased, but the research group was significantly higher than the control group; the total incidence of adverse reactions of patients 48 h after surgery in the research group was 6.67%, which was significantly lower than that in the control group (23.33%) (all P<0.05). Conclusion The application of sevoflurane anesthesia in the laparoscopic surgery for elderly patients with cholecystolithiasis can achieve better anesthesia effect, with little impact on the patient's hemodynamics, cognitive function and mental state, the stress reaction is mild, the postoperative adverse reactions is less relatively, and with more security