Opioid-free Anesthesia for Open Cardiac Surgery: A Prospective Randomized Controlled Trial

Inclusion Criteria: * Male or female ≥ 18 years of age at the time of consent. * Undergoing non-emergent open cardiac procedures requiring cardiopulmonary bypass support, including: CABG, aortic aneurysm repair, valve repair/replacement, or CABG in combination with valve repair/replacement. * Ability and willingness to provide written informed consent. Exclusion Criteria: * Chronic opioid use defined as preoperative MED \>100 daily. * Hypersensitivity or contraindication to any of the study medications. * Pre-existing Alzheimer's/vascular dementia. * Pre-existing psychiatric disorder precluding ability to provide informed consent or use a visual analogue scale for pain. * Childs-Pugh Class C liver failure or acute liver failure. * Emergent open heart surgery, including type A aortic dissections, trauma, or conversion (bail out) from another procedure such as cardiac catheterization, ablation, transcatheter aortic valve replacement or any other general surgical procedure. * Pregnancy or lactating. * Inability to comply with the requirements of the study, per investigator judgment. * Patients determined to need an awake intubation.