Objective To observe the effects of sevoflurane inhalation anesthesia on cognitive function and postoperative delirium after minimally invasive surgery in elderly patients. Methods A total of 80 elderly patients who underwent laparoscopic cholecystectomy in Yangjiang People's Hospital from October 2022 to October 2023 were selected as study subjects. According to the random number table method, they were divided into an observation group （sevoflurane inhalation anesthesia） and a control group （propofol pump injection anesthesia）, with 40 patients in each group. The serum central nervous system specific protein （S100β） level was detected before and after surgery; the cognitive function was evaluated using the mini-mental state examination （MMSE） and the Montreal cognitive assessment （MoCA） before and after surgery; the postoperative delirium was determined according to the confusion assessment method （CAM） score, and the incidence of postoperative delirium was calculated. The differences in the above observation indicators were compared between the two groups. Results After surgery, the S100β level in the observation group was significantly lower than that in the control group （P<0.05）. The postoperative cognitive function scores （MMSE and MoCA scores） in the observation group were significantly higher than those in the control group （P<0.05）. The incidence of postoperative delirium in the observation group was 5.00%, lower than 10.00% in the control group, but the difference between the groups showed no statistically significance （P>0.05）. Conclusion Sevoflurane inhalation anesthesia has a protective effect on central nervous cells, which can effectively reduce the impact on cognitive function after minimally invasive surgery in elderly patients, and will not increase the incidence of postoperative delirium.