Patients receive sedative medication, typically midazolam 2-4mg iv. An infusion of dexmedetomidine will be started. Patients younger than 65 years will receive a loading dose of 1mcg/kg over 10 minutes. In patients older than 65 years 0.5 mcg/kg will be given as a loading dose. After administration of the loading dose an infusion will be continued throughout the duration of the surgery at a dose of 0.1-1mcg/kg/h. The infusion will be discontinued at the end of surgery. General anesthesia will be induced with a single dose of Lidocaine and Propofol with either Succinylcholine or Rocuronium given to provide intubating conditions. The patient's trachea will be intubated and mechanical ventilation started. General anesthesia will be maintained with an infusion of dexmedetomidine and propofol and titrated to the desired level of anesthesia. Ketamine will be administered as an adjunctive analgesic at a dose of 0.5 mg/kg. Neuromuscular blockade appropriate for surgical conditions will be provided by either the long acting neuromuscular blocking agents (NMBA), Rocuronium or Vecuronium, at the anesthesia providers discretion. At the conclusion of the operation the degree of NMB/paralysis will be assessed and a NMBA reversal administered (see detailed description below). Patients will be extubated after the end of surgery and transported to the PACU.