As the field of pediatric procedural sedation continues to expand, so does the exploration of medications that have a role in such invasive and noninvasive procedures. One such medication that has emerged during the last decade is dexmedetomidine, a drug approved for use in the adult intensive care setting. Its role in pediatrics has varied in its use from sedation in ventilated children in the intensive care unit to treatment for emergence reactions from general anesthesia and in sedation needed for radiographic imaging studies, electroencephalography, and invasive procedures. This review article presents the pediatric studies that have been published thus far regarding dexmedetomidate in the nonventilated, spontaneously breathing patient and identifies those patients where the use of this agent may not be indicated.