Abstract： AIM To explore the effect of dexmedetomidine on maintenance of anesthesia and hemodynamics in elderly patients undergoing laparoscopic cholecystectomy. METHODS One hundred patients aged > 70 years who were treated from September 2015 to September 2017 at the Second Affiliated Hospital of Wenzhou Medical University were randomly divided into a control group (50 cases) and an observation group (50 cases). All the patients received laparoscopic cholecystectomy. The control group was given propofol and remifentanil for anesthesia maintenance, and the observation group was given dexmedetomidine and remifentanil. Bispectral index(BIS), heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) before anesthesia (T0) and at insertion of mask (T1), beginning of surgery (T2), ending of surgery (T3), and withdrawal of mask (T4) as well as visual analogue scale (VAS) after awakening, improved OAA/S ratings, and adverse reactions were observed. RESULTS There was no significant difference in BIS between the two groups at different time points from T0 to T4(P> 0.05). At the time points of T1-T4, HR, DBP, and SBP of the observation group were significantly lower than those of the control group (P< 0.05). There was no significant difference in VAS or improved OAA/S ratings between the two groups after resuscitation (P> 0.05). In addition, there was no statistical difference in the incidence of adverse reactions between the two groups (P> 0.05). CONCLUSION Treatment with dexmedetomidine in elderly patients undergoing laparoscopic cholecystectomy has a significant effect in maintaining intraoperative anesthesia and can effectively maintain hemodynamics with good safety.