Backround and Aims: Mastoid surgery can be performed under general anaesthesia (GA) or sedation both combined with regional anaesthesia ((RA). There are very few studies comparing both the techniques. Dexmedetomidine is the sedative agent of choice in modern era. Our primary aim was comparison of haemodynamic variation and bleeding under GA or sedation with dexmedetomidine and secondary being, adequacy of sedation and patient comfort under dexmeditomedine sedation, post operative analgesia and duration of stay in post anaesthesia care unit. Methods: 60 patients posted for mastoidectomy were randomly divided into two equal groups, GA or sedation. In GA after conventional technique of induction and intubation, anaesthesia was maintained with oxygen, nitrous oxide, isoflurane and propofol infusion. In sedation group dexmedetomidine 1 g/kg was given over ten minutes followed by infusion at rate 0.2-0.8 g/kg/hr. RA was given in both the groups. Intraoperative parameters were noted in both the groups. Statistical software version SPSS 19 was used. Results: Heart rate was lower in sedation group throughout surgery. Bleeding was less in both groups. None of the patients in sedation group were converted to GA. Maximum patients had discomfort to noise and neck position. Shifting of patients was earlier with sedation than in GA. There was longer post operative analgesia with dexmedetomidine sedation. Conclusion: Dexmedetomidine sedation with regional anaesthesia can also be a better choice for mastoid surgery. It maintains haemodynamic stability, minimal bleeding, adequate sedation and patient comfort. It also aids early ambulation of patients and has perioperative analgesic action.