Objective　To compare the clinical efficacy of dexmedetomidine （Dex） with Midazolam for awake tracheal intubation with Shikani optical stylet in patients undergoing cervical vertebral surgery， and evaluate the clinical value of Dex.　Methods　Thirty ASA Ⅰ-Ⅱ patients undergoing cervical vertebral surgery and slow induction of anesthesia were randomly assigned to Dex group （group D， n=15） and Midazolam group （group M， n=15）. The group D received a loading dose of 1 μg/kg Dex intravenously over 10 min， and followed by continuous infusion at a rate of 1 μg·kg-1·h-1 in group D； Group M received 0.08 mg/kg Midazolam intravenously and followed by 0.02 mg/kg intermittent bolus until the desired depth of sedation was reached. After the topical upper airway anaesthesia with 150 mg of 2% lidocaine， awake orotracheal intubation was performed using Shikani optical stylet. The intubation conditions （coughing， limb movement）， the tolerance to intubation and the level of cooperation of the patient were evaluated. The time of intubation， the frequency of intubation， adverse effects or complications such as hemodynamic change， injury in pharyngo?蛳oral cavity， respiratory depression were observed. The incidence and severity of sore throat and memory of intubation were recorded at 24 h after surgery.　Results　There was no difference between group in the time required for intubation and the frequency of successful intubation （P>0.05）. Compared to group M， the extremities s movement， the tolerance to intubation， the level of cooperation and hemodynamic changes of the patients in group D were better （P<0.05）. The respiratory depression was observed in three cases in group M. There were two cases in the group M and one case in the group D who have vague memory of intubation at 24 h after surgery.　Conclusions　Slow induction of Dex is more desirable than Midazolam for intravenous sedation， for it provides favorable conditions and tolerance， few side effects for awake orotracheal intubation with Shikani optical stylet in patients undergoing cervical vertebral surgery.