Dexmedetomidine sedation is generally considered a safe and effective anesthesia method. However, successfully controlling a patient's anxiety, tension, and discomfort is still a challenge when using dexmedetomidine sedation during deep brain stimulation surgery. 31 patients with Parkinson's disease who were undergoing subthalamic nucleus deep brain stimulation treatment were enrolled in this study. Randomized case-control analysis was conducted with a local anesthesia (LA) group (n = 16) and a dexmedetomidine sedation (DEX) group (n = 15). The sedation protocol used bispectral index (BIS) feedback to guide the low-dose dexmedetomidine administration process. The indicators used for comparison between the 2 groups of patients undergoing deep brain stimulation surgery included: discomfort degree, blood pressure control, amplitude of neuronal firing suppressed during microelectrode recording, as well as complications of intracranial hemorrhage, confusion, and seizure. The mean visual analog scale (VAS) score of discomfort degree in the DEX group was 2.33 +/- 0.816, which was lower than that of the LA group (4.06 +/- 0.68) (P = 0.000). The mean arterial pressure in the 2 groups was below 95 mmHg and decreased during the deep brain electrode implantation compared with the baseline value. One elderly patient with an inhibited microelectrode recording was identified in the DEX group, and one case of intracranial hemorrhage was identified in the LA group, with no other complications. BIS-guided dexmedetomidine sedation can significantly improve patients' comfort and meet blood pressure requirements during deep brain stimulation surgery, compared with local anesthesia. Elderly patients with Parkinson's disease require a reduced dose of dexmedetomidine.