This document discusses the use of dexmedetomidine (Dex) in neuroanesthesia. It describes how Dex leads to sedation, analgesia and decreases in heart rate and blood pressure through activation of α2 receptors. Studies show Dex causes a reduction in cerebral blood flow in animals but not cerebral metabolic rate of oxygen. In humans, Dex decreases cerebral blood flow velocity. Dex also has little effect on intracranial pressure and neurophysiological monitoring. The document reviews clinical experiences using Dex for craniotomies, spinal fusions and carotid endarterectomies. It concludes that Dex's properties support its potential use in neuroanesthesia practice.