Abstract: Objective：To evaluate the sedative effect of dexmedetomidine and fentanyl for awake tracheal intubation. Methods：This study was conducted on a total of 60 elderly inpatients scheduled for elective orthopedic surgery, who were randomly divided into two groups. The patients in the experimental group were given dexmedetomidine 1 μg/kg, and the control group was given fentanyl 1 μg/kg. Prior to tracheal intubation, local anesthesia was applied to the trachea mucosa and larynx. The intubation condition was evaluated by the cough severity score and the postintubation tolerance score. Incidence of hemodynamic changes, Ramsay sedation score, respiratory rate and hypoxic episodes (SpO2＜90 %) were recorded and compared between two groups. At 24hour followup, adverse events such as hoarseness and sore throat were also assessed. Results：Compared with the control group, the cough severity score of the experimental group decreased significantly, the Ramsay sedation score increased significantly, the mean arterial pressure decreased significantly, and the number of hypoxic episodes (O2 saturation <90%) decreased significantly （P＜0.05）. There was no significant difference in adverse events (hoarseness and sore throat) between the two groups. Conclusions：Compared with fentanyl, dexmedetomidine can provide adequate sedation for elderly patients with hemodynamic stability during awake tracheal intubation.