【Abstract】 Objective To explore the application value of propofol combined with dexmedetomidine and fentanyl in painless tracheoscopy. Methods 90 patients undergoing tracheoscopy in our hospital during January 2016 to February 2017 were selected as subjects. According to different methods of anesthesia, the patients were divided into the painless group (propofol combined with dexmedetomidine and fentanyl anesthesia, n=48) and the single group (propofol anesthesia alone, n=42). The hemodynamic parameters ［systolic pressure (SBP), diastolic pressure (DBP), heart rate (HR), oxygen saturation (SpO2)］ in the two groups were observed before and after anesthesia. The anesthetic effects (onset time, duration of analgesia, compliance), duration of tracheoscopy and the incidence of adverse reactions were compared between the two groups. Results There were no significant differences in SBP, DBP, HR and SpO2 between the two groups at T0 (P > 005). Compared with T0, there were no obvious changes of SBP, DBP, HR and SpO2 of the painless group at T1, while in the single group, SBP and DBP increased, HR accelerated, and SpO2 decreased significantly (P < 005). At T2, SBP and DBP decreased, HR accelerated and SpO2 decreased in the painless group while there were no obvious changes in the single group (P>005). The onset time and duration of tracheoscopy in the painless group were significantly shorter than those in the single group, the duration of analgesia was significantly longer than that in the single group and patients’ compliance was significantly better than that of the single group (P<005). The total incidence of adverse drug reactions was lower in the painless group than the single group after anesthesia (3125% vs 4762%) (P<005). Conclusion The anesthesia with propofol combined with dexmedetomidine and fentanyl has more advantages over single drug anesthesia in painless tracheoscopy. The combined medication can not only effectively stabilize hemodynamics but also obtain the best anesthetic effects, improve the compliance and shorten the time for examination, with high drug safety.