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Background Pneumoperitoneum during laparoscopic surgery has a systemic impact on the renal system and might contribute to acute kidney injury or postoperative renal dysfunction. However, effective preventive strategies are still lacking. We aimed to explore the effects of dexmedetomidine (DEX) on kidney and other organ function in patients undergoing elective laparoscopic surgery for colorectal cancer. Materials and methods Fifty-six patients were randomly enrolled into the Control or DEX group. The DEX group received 1 µg kg−1 DEX intravenously within 10 min followed by a maintenance dose of 0.5 µg kg−1 h−1 infused until 30 min before closing the peritoneum. In the Control group, 0.9% sodium chloride was administered as a placebo. The primary outcome was serum neutrophil gelatinase-associated lipocalin (NGAL) levels reflecting kidney injury. Secondary outcomes included variables reflecting the kidney, intestinal injury and systemic inflammatory response. Results NGAL levels were significantly lower in the DEX group than in the Control group at 1 d and 5 d postoperatively (107.5 ± 55.6 ng mL−1 versus 179.5 ± 78.2 ng mL−1; 70.3 ± 45.8 ng mL−1 versus 135.2 ± 59.6 ng mL−1, P Conclusions Perioperative DEX administration may potentially confer kidney and intestinal protection during laparoscopic surgery for colorectal cancer patients.