Background The aim of this study was to investigate the influence of adenosine triphosphate (ATP)-binding cassette transporter subfamily B member 1 (ABCB1) gene polymorphism on the efficacy of Remifentanil. Material/Methods A total of 276 patients undergoing elective surgeries were included to collect general clinical information and detect the polymorphism of ABCB1 rs1045642 using the TaqMan-MGB probe, and they were divided into 3 groups – a genotype AA group, a genotype AG group, and a genotype GG group – based on different genotypes of ABCB1 rs1045642. Results The comparisons showed that there were no differences in sex, age, body mass index (BMI), smoking, drinking status, or ASA class among the 3 groups ( P >0.05). The genotype GG group had higher consumption of Remifentanil than the genotype AA group ( P <0.05), but the genotype AG group was not different from the genotype AA and GG groups ( P >0.05). Comparison of the surgery duration revealed no difference among the 3 groups ( P >0.05). The analepsia time, autonomous respiratory recovery time, and orientation recovery time in the genotype GG group were longer than in the genotype AA group ( P <0.05), but the genotype AG group was not different from the genotype AA and GG groups ( P >0.05). There were no differences in adverse reactions among the 3 groups ( P >0.05). Conclusions ABCB1 gene polymorphism can affect the clinical efficacy of Remifentanil.