Introduction: Dexmedetomidine has been demonstrated to provide successful sedation without impairment of electrophysiologic monitoring in functional neurosurgery. We present a case series comparing the safety and efficacy of dexmedetomidine and remifentanil in patients undergoing DBS surgery.Case description: In the study, a 48-year-old male received dexmedetomidine; a 53-year-old female received remifentanil. Dexmedetomidine patients scored 3 on the OAA/S scale, remifentanil patients scored 2. Dexmedetomidine maintained blood pressure at 160 mmHg, while remifentanil maintained it at 120 mmHg. No adverse events were reported for either drug. Dexmedetomidine required fentanyl rescue in the second hour of surgery. Median recovery time was 15 minutes for all patients. Dexmedetomidine patients recovered in 2 hours, remifentanil patients in 4 hours. Both groups had similar 24-hour VAS scores for pain intensity.Conclusions: Both dexmedetomidine and remifentanil were well-tolerated during surgery. Dexmedetomidine induced moderate sedation, with faster recovery times. Future research should explore optimal dosing and recovery factors.