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Context Brainstem tumour surgery is difficult, and accidents can easily occur. Objective To explore the effect of dexmedetomidine hydrochloride on brainstem tumour surgery. Design, setting and participants A total of 60 patients with brainstem tumours successfully operated on by our hospital from March 2016 to March 2018 were selected as subjects. Interventions These patients were randomised into two groups: the research group ( n = 30) and control group ( n = 30). Patients in the control group were given propofol together with a placebo (0.9% sodium chloride solution) to maintain anaesthesia after general anaesthesia, while patients in the research group were supplemented with dexmedetomidine hydrochloride. Main outcome measure Awakening time, overall stability of various indicators in the operation and adverse reactions during the awakening period were observed. Results The results revealed that patients in the research group had a longer awakening time, higher mean stability rate, higher effective rate and less incidence of adverse reactions during the awakening period than the control group; the differences were all statistically significant ( P < 0.05). Conclusion Dexmedetomidine hydrochloride has a good analgesic effect in intraoperative anaesthesia during brainstem tumour surgery, which significantly reduces the incidence of adverse reactions. Therefore, it can be used to assist anaesthesia during brainstem tumour operations and is worthy of clinical popularisation and application.