This trial refuted the hypothesis that balanced opioid-free anesthesia with dexmedetomidine, compared with remifentanil, would result in fewer postoperative opioid-related adverse events. Conversely, it did result in a greater incidence of serious adverse events, especially hypoxemia and bradycardia.

The study was stopped prematurely because of five cases of severe bradycardia in the dexmedetomidine group.

The primary composite outcome occurred in 122 of 156 (78%) dexmedetomidine group patients compared with 105 of 156 (67%) in the remifentanil group.

Hypoxemia occurred 110 of 152 (72%) of dexmedetomidine group and 94 of 155 (61%) of remifentanil group patients.

There were no differences in ileus or cognitive dysfunction.

Cumulative 0 to 48 h postoperative morphine consumption and postoperative nausea and vomiting were both less in the dexmedetomidine group, whereas measures of analgesia were similar in both groups.

Dexmedetomidine patients had more delayed extubation and prolonged postanesthesia care unit stay.

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