INTRODUCTION: This systematic review appraises the clinical evidence on efficacy and safety of dexmedetomidine (DEX), as a sole sedative or as sedative adjunct in adult neurocritical care (NCC) patients.MATERIALS AND METHODS: A database search was conducted to identify randomized clinical trials and observational studies reporting the use of DEX alone or as adjunct for sedation in NCC setting. The primary outcome was the occurrence of hemodynamic changes, whereas the secondary outcomes were sedative and analgesic efficacy, quality and time to awakening, and development of adverse events.RESULTS: Eight trials including 3 randomized controlled trials and 5 observational studies, enrolling 650 patients, were selected. All the retrieved studies had a high risk of bias and a low to moderate quality. Dexmedetomidine provided a better sedation score and reduced analgesic requirements when compared to propofol or midazolam sedation. No statistically significant difference in the combined hemodynamic effect (hypotension or bradycardia) between DEX and controls (risk ratio, 1.50; 95% confidence interval, 0.65-3.48; P = 0.34; I = 56%) was identified. Adverse events were not consistently reported.CONCLUSIONS: Available clinical literature supporting the efficacy and safety of DEX use in adult NCC setting is of limited quantity and quality. However, from the current evidence on the use of DEX in NCC, as sole sedative agent or as an adjunct, seems to be both efficient and safe.