Background. In laparoscopic cholecystectomy (LCE), general anesthesia has its own characteristics due to the creation of pneumoperitoneum, changes in body position and adsorption of insufflated gas, which causes the occurrence of perioperative complications and requires improvement of anesthesiology programs. Objective: to determine the efficacy and safety of combined low opioid anesthesia based on dexmedetomidine in complex anesthesia in patients undergoing laparoscopic surgery for acute cholecystitis. Materials and methods. In total, the study included 163 patients undergoing LCE under general anesthesia. All patients were divided into 3 groups according to the anesthetic care scheme. In Group 1 (n=56), low-opioid anesthesia (dexmedetomidine, lidocaine, fentanyl 1–2 μg/kg/h) and artificial ventilation were performed; Group 2 (n=52): propofol with fentanyl (4–6 μg/kg/h) and artificial ventilation. In Group 3 (n=55): anesthesia with sevoflurane in combination with fentanyl and artificial ventilation. Results. Hyperdynamic reactions were observed in Group 2 and Group 3 at the beginning of the operation: heart rates and BP values after induction, with intubation in the 3rd, 5th and 7th minute of pneumoperitoneum, were slightly higher in Group 2 and 3 than in Group 1. However, moderate bradycardia was observed in Group 1 more often – in 5 patients (8.92%) than in patients in Group 2 and Group 3 – 2 cases (3.84%) and 2 cases (3.64%), respectively. The total number of injected analgesics during LCE was: in Group 1 – 141.52±23.64 μg, in Group 2 – 426.92±39.41 μg, in Group 3 – 354.75±28.63 μg (p <0.01). Only one patient in Group 1 required ondansetron for the treatment of PONV compared to 5 and 4 in Group 2 and Group 3, respectively (p <0.05). None of the patients in all groups reported “feeling” intraoperative events or “awakening during surgery”. Conclusions. The use of dexmedetomidine with lidocaine infusion three times reduced the use of opioids in the intraoperative period and to refuse their use in the postoperative period. With the use of low-opioid anesthesia in the postoperative period, the frequency of hypertensive reactions and tachycardia did not increase, but in the postoperative period, these p