BackgroundBecause adenosine has been alleged to produce both anesthetic and analgesic sparing effects, a randomized, double‐blinded study was designed to compare the perioperative effects of adenosine and remifentanil when administered as intravenous adjuvants during general anesthesia for major gynecologic procedures.MethodsThirty‐two women were assigned randomly to one of two drug treatment groups. After premedication with 0.04 mg/kg intravenous midazolam, anesthesia was induced with 2 [micro sign]g/kg intravenous fentanyl, 1.5 mg/kg intravenous propofol, and 0.6 mg/kg intravenous rocuronium, and maintained with desflurane, 2%, and nitrous oxide, 65%, in oxygen. Before skin incision, an infusion of either remifentanil (0.02 [micro sign]g [middle dot] kg‐1[middle dot] min‐1) or adenosine (25 [micro sign]g [middle dot] kg‐1[middle dot] min‐1) was started and subsequently titrated to maintain systolic blood pressure, heart rate, or both within 10‐15% of the preincision values.ResultsAdenosine and remifentanil infusions were effective anesthetic adjuvants during lower abdominal surgery. Use of adenosine (mean +/− SEM, 166 +/− 17 [micro sign]g [middle dot] kg‐1[middle dot] min‐1) was associated with a significantly greater decrease in systolic blood pressure and higher heart rate values compared with remifentanil (mean +/− SEM, 0.2 +/− 0.03 [micro sign]g [middle dot] kg‐1[middle dot] min‐1). Total postoperative opioid analgesic use was 45% and 27% lower in the adenosine group at 0‐2 h and 2‐24 h after surgery, respectively.ConclusionsAdjunctive use of a variable‐rate infusion of adenosine during desflurane‐nitrous oxide anesthesia was associated with acceptable hemodynamic stability during the intraoperative period. Compared with remifentanil, intraoperative use of adenosine was associated with a decreased requirement for opioid analgesics during the first 24 h after operation.