〔Abstract〕 Objective To study the effects of dexmedetomidine combined with remifentanil on perioperative period of elderly patients undergoing orthopedic surgery. Methods 110 elderly patients who underwent orthopedic surgery in Zhoukou Hospital of Traditional Chinese Medicine (TCM) from April 2018 to March 2021 were selected and randomly divided into an observation group and a control group, with 55 cases in each group. The control group was anesthetized with propofol and remifentanil, and the observation group was anesthetized with dexmedetomidine and remifentanil. The changes in perioperative heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), arterial oxygen saturation (SpO2), recovery quality and cognitive function were observed and compared between both groups of patients. Results At 30 min after anesthesia (T3) and after waking up (T4), the HR and MAP in the observation group were higher than those of the control group (P < 0.05). The RR and SpO2 in the observation group at 10 min after anesthesia (T2) and at T3 were higher than those of the control group (P < 0.05). Ramsay Sedation Scale (RSS) score in the observation group was lower than that of the control group at 20 min and 30 min after surgery (P < 0.05). There was no statistical significance in the score of Montreal Cognitive Assessment Scale (MoCA) between the two groups (P > 0.05). Conclusion Dexmedetomidine combined with remifentanil can improve the perioperative respiration and hemodynamics in the treatment process of elderly patients undergoing orthopedic surgery, and it has good recovery quality and has no significant impact on cognitive function.