Dexmedetomidine has been shown to provide good perioperative hemodynamic stability with decreased intraoperative opioid requirements. This study was conducted to compare the effect of dexmedetomidine-remifentanil (DR) anesthesia and propofol-remifentanil (PR) anesthesia on perioperative hemodynamics and postanesthesia. recovery profiles in patients undergoing intracranial surge After receiving Ethics Committee approval and informed patient consent, 78 American Society of Anesthesiologists physical status I or II patients between the ages of 19 and 70 years with a Glasgow Coma Scale score 14 or 15 who were scheduled for elective intracranial surgery with general anesthesia were recruited. Anesthesia induction was provided by intravenous remifentanil (0.5 mu g/kg) and propofol (1.5-2 mg/kg) in both groups and maintained with infusion of DR (0.6-1.2 mg/kg/h and 0.25 mu g/kg/min)-nitrous oxide/oxygen (n(2)o/o(2)) in the DR group (n = 39) and infusion of PR (3-10 mg/kg/h and 0.25 mu g/kg/min)-n(2)o/o(2) in the PR group (n = 39). Hemodynamic variables were recorded before surgery, during the induction of anesthesia, after intubation, and during application of the headholder and skin incision; brain relaxation was also recorded. Times to extubation and awakening, eye opening, and response to commands as well as analgesic requirements were recorded after surgery. No significant difference was found in systolic blood pressure and mean arterial pressure throughout the study period except at the time of the dural incision (P < 0.05). These variables were significantly lower in the DR group (P < 0.05). Brain relaxation scores were similar between the 2 groups (P > 0.05). Time to extubation was significantly shorter in patients receiving PR anesthesia than in patients receiving DR anesthesia (3.6 minutes vs. 5.5 minutes). Analgesic requirements were significantly higher in the PR group than in the DR group (P = 0.013). No significant side effects were reported in the 2 groups (P > 0.05). In conclusion, dexmedetomidine (0.6-1.2 mu g/kg(-1)/h(-1)) Plus remifentanil (0.25 mu g/kg(-1) min(-1)) anesthesia offered lower analgesic requirements, a longer extubation time, and better hemodynamic stability compared with PR anesthesia for patients undergoing intracranial surgery.