Nasal administration is characterized in non-invasion and good compliance, and can quickly target on the brain via the olfactory nerve pathway and olfactory mucosal epithelial pathway. Dexmedetomidine (Dex) can be absorbed into the systemic circulation through the nasal mucosa after nasal administration, or become active within the unique direct channels between the nasal cavity and the brain at a small amount, which avoids the first-pass effect, with high bioavailability. The current study is to review the articles concerning the application and research of Dex in monitoring anesthesia management (MAC) through the nasal cavity. This paper introduces the anatomical and physiological characteristics and clinical advantages of Dex after nasal administration, and discusses the research, safety and clinical application scope of Dex transnasal drug in MAC. Nasal administration of Dex will provide new thoughts on clinical treatment, and Dex recommended doses, indication and clinical experience are gradually accumulating.