Objective: To compare the sedative and analgesic outcomes of dexmedetomidine with midazolam for monitored anesthesia care (MAC) in patients undergoing Septoplasty. Methodology:  This comparative study was conducted at Shalamar Medical and Dental College Lahore from March 2019 to August 2020. A total of 150 patients who were planned for Septoplasty under MAC having age 18-45 years, and ASA status I-II in Shalamar Medical and Dental College Lahore. Patients were randomly divided into two equal groups; In group D; IV dexmedetomidine 1 µg.Kg-1 was given over five mins after that IV infusion at the rate of 0.5 µg.Kg-1.hour-1 was started. In group M; midazolam 0.06 mg.Kg-1 was given as slow bolus after that continuous infusion at the rate of 0.01 mg.Kg-1.hour-1 was started. Sedation was monitored according to Ramsay sedation scale and VAS scale was used to measure the intensity of pain. Results: The Mean age was 34.3±5.7 years in group D versus 35.7±6.1 years in group M. There were 49 (65.3%) male patients in group D and 47 (62.7%) in group M. Mean sedation and pain score was significantly less in group D as compared to group M (p-value 0.001 & 0.002 respectively). There were 12 (16.0%) patients in group D who required rescue sedation and 32 (42.7%) in group M required rescue sedation (p-value 0.003). There were 14 (18.7%) patients in group D who required rescue analgesia versus 29 (38.7%) in group M (p-value 0.006). Conclusion: Use of dexmedetomidine for MAC is advantageous as compared to midazolam in-terms of better sedation and analgesia and reduced requirements of rescue doses of sedatives and analgesics.