Pre-operative anxiety leads to higher sympathetic stimulation. Propofol in the main drug used during interventional or imaging techniques that need sedation. Also, dexmedetomidine causes sedation, analgesia, sympatholytic properties, without respiratory depression.In stereotactic brain biopsy; patient discomfort due to drilling a hole through the skull and the advancement of the biopsy needle make the patient in need for good sedation and analgesia.

Inclusion criteria:

Patients with:

• brain secondaries from the lung/breast/pancreas
• tuberculoma
• pyogenic abscess
• intra-axial supratentorial space occupying lesion with or without hydrocephalus *an average duration of the procedure 1- 2hr 30 min
• an available caregiver for overnight observation
• patient relative proximity to the hospital Exclusion criteria

Patients with:

• morbid obesity (body mass index >35 kg/m2)
• significant comorbidities (a known history of hepatic disease, renal dysfunction, hypertension, and chronic pain)
• history of drug or alcohol abuse
• an allergic reaction to one of the study medications
• anticipated difficult airway
• uncontrolled epilepsy
• poor neurological status
• neuropsychological unsuitability taking psychotropic drugs (benzodiazepines and barbiturates)
• patients with brain stem lesions (vital areas of brain)
• un-cooperative
• refusing adults
• patients with ventricular drain
• already inpatient
• Intubated patients and those who had a prior craniotomy .