Dexmedetomidine clinical effects mediated via activation of (α-)2-adrenergic and imidazoline receptors. Through the presynaptic α-2A-adrenoreceptors agonism, dexmedetomidine induces sedation, anxiolysis, hipnose, analgesia, neuroprotection, reduces insulin release, reduces heart rate and contractility, producing vasodilation. In addition, agonistic effect on α-2C- adrenoreceptors induces sedation, mood and cognition modulation, sensorial processing, and reduction of adrenal medulla epinephrine. By the postsynaptic α-2B-adrenoreceptors agonism, dexmedetomidine causes analgesia at spinal level, vasoconstriction (with high-bolus doses), improve of diuresis, and central inhibition of shivering. Dexmedetomidine acts also at imidazoline receptors, with a neuroprotection mechanism (imidazoline-2) and with antiarrhythmic effect (imidazoline-1).