Awake craniotomy (AC) may be required when neurological injury is affecting eloquent areas of the brain. Several anesthetic approaches have been proposed such as the asleep-awake- asleep (AAA) technique, the conscious sedation and recently the awake-awake-awake technique. Our institution follows a conscious sedation protocol since 2008 with the use of dexmedetomidine as the main anesthetic agent. The aim of this study is to review the anesthetic management of AC in our institution following our current protocol.