Objective To analyze the effects of remifentanil combined with propofol anesthesia on pain and respiratory depression during painless abortion under different anesthesia depth index monitoring. Methods A total of 249 patients undergoing painless abortion in the hospital were enrolled from January 2020 to June 2021. According to simple random grouping method, they were divided into groups A, B and C, 83 cases in each group. All the three groups were treated with remifentanil and propofol for anesthesia. The Narcotrend indexes in groups A, B and C were within 27-36, 37-46 and 47-56, respectively. The anesthesia effect, analgesia effect, respiratory depression, anesthesia recovery time and incidence of adverse reactions were compared among the three groups. Results The good rates of anesthesia in groups A, B and C were 81.93%, 96.39% and 85.54%, respectively. The good rate of anesthesia in group B was significantly higher than that in groups A and C (P<0.05), but there was no significant difference between group A and group C (P>0.05). There was no significant difference in total response rate of analgesia between group A and group B (P>0.05), which was significantly lower in group C than group A and group B (P<0.05). The total incidence of respiratory depression in group A was significantly higher than that in group B and group C (P<0.05), but the difference between group B and group C was not statistically significant (P>0.05). The recovery time of anesthesia in group A was significantly longer than that in groups B and C (P<0.05), but there was no significant difference between group B and group C (P>0.05). The total incidence of adverse reactions in group B was significantly lower than that in groups A and C (P<0.05), but there was no significant difference between group A and group C (P>0.05). Conclusion The anesthesia and analgesia effects of remifentanil combined with propofol anesthesia (Narcotrend indexes of 37-46) are significant during painless abortion, which can effectively alleviate respiratory depression, with short recovery time and few adverse reactions.