Abstract Dexmedetomidine is a highly selective alpha 2 agonist with properties of sedation, analgesia and anxiolysis. The purpose of this narrative review was to assess the effect and safety of dexmedetomidine in not only decreasing the magnitude of haemodynamic responses to laryngoscopy, surgery and pneumoperitoneum especially when used together with fentanyl but also decreases the dose of opioids and anaesthetics in achieving adequate analgesia and anaesthesia respectively. Intraoperative administration of dexmedetomidine is associated with decreased postoperative pain, opioid and analgesic consumption and it assures haemodynamic stability.