Background <p>Awake craniotomy is the gold standard for resecting brain tumors in eloquent areas. This technique requires tailored anesthetic management to ensure patient safety and cooperation. We aimed to describe clinical characteristics, anesthetic management, and intraoperative outcomes in patients undergoing awake craniotomy at a high-complexity hospital in southwestern Colombia.</p> Methods <p>We conducted a retrospective case series. Sociodemographic, clinical, and intraoperative data were obtained from electronic medical records. Descriptive statistics were used to summarize the findings.</p> Results <p>Fifteen patients underwent awake craniotomy with monitored anesthesia care using dexmedetomidine and remifentanil. All patients received a scalp block, non-opioid analgesics, and antiemetic prophylaxis. The most frequent adverse event was transient bradycardia without hemodynamic instability. No respiratory or neurological complications occurred. All procedures were successfully completed.</p> Conclusions <p>Awake craniotomy under monitored anesthesia care with dexmedetomidine and remifentanil was feasible, safe, and well tolerated in this cohort. The absence of serious complications highlights the value of structured anesthetic protocols and trained multidisciplinary teams. This experience provides reference for the adoption of similar strategies in hospital settings across Latin America, where implementation of awake craniotomy remains limited.</p>