Dexmedetomidine is a relatively selective alpha2 agonist with sympatholytic, sedative, amnestic, and analgesic properties. It is indicated for the short-term sedation of patients needing mechanical ventilation in the intensive care unit. Recent reports have been published describing dexmedetomidine as a useful adjunct in both regional and general anesthesia. A few case studies have demonstrated successful use of dexmedetomidine as a replacement agent for opioids in patients in whom airway compromise was a concern. This article will provide the reader with a comprehensive review of the pharmacology, pharmacokinetics, and adverse effects of dexmedetomidine. A thorough understanding of this drug will enable the anesthesia provider to determine situations in which dexmedetomidine may be a useful drug to consider, whether as an adjunct or as a sole agent.