Objective: To investigate the application effect of bedside ultrasound-guided anesthesia management in elderly patients with emergency intestinal obstruction undergoing surgery, and to provide a reference for optimizing perioperative anesthesia management for such patients in primary-level hospitals. Methods: A total of 107 elderly patients with emergency intestinal obstruction who underwent surgery under general anesthesia in our hospital between June 2024 and March 2026 were prospectively enrolled. Forty-nine patients in the control group received anesthesia management based on routine vital-sign monitoring combined with clinical experience. On the basis of conventional management, 58 patients in the study group underwent bedside transthoracic ultrasound assessment of respiratory variation in inferior vena cava diameter, left ventricular volume and systolic function, and pulmonary edema and atelectasis; the ultrasound findings were used to guide anesthesia induction, volume supplementation, and vasoactive drug administration. The incidence of intraoperative cardiovascular adverse events, postoperative ICU admission rate, length of ICU stay, total length of hospital stay, and 24-hour postoperative mortality were compared between the two groups. Results: The incidence of intraoperative cardiovascular adverse events was lower in the study group than in the control group (62.07% vs 83.67%, χ² = 6.144, P = 0.013). There were no statistically significant differences in the postoperative ICU admission rate or 24-hour postoperative mortality between the two groups (P > 0.05). The length of ICU stay [(2.0 ± 1.0) d] and total length of hospital stay [11.0 (9.0, 16.0) d] in the study group were shorter than those in the control group [(2.6 ± 1.3) d and 13.0 (10.0, 17.0) d, respectively], and the differences were statistically significant (P < 0.05). Conclusion: Bedside ultrasound-guided anesthesia management can reduce the risk of intraoperative cardiovascular adverse events and shorten the length of ICU stay and total length of hospital stay in elderly patients with emergency intestinal obstruction. It is helpful for improving postoperative recovery and has clinical application value for enhancing surgical anesthesia safety for such patients in primary-level hospitals.