BACKGROUND Direct laryngoscopy and endotracheal intubation elicits a haemodynamic response associated with increased heart rate and blood pressure. The aim of the study is to compare the efficacy of intravenous dexmedetomidine and fentanyl in attenuation of stress response to laryngoscopy and intubation. MATERIALS AND METHODS Study was carried out on 60 patients belonging to ASA grade I & II, aged 15 to 65 years including either gender scheduled for elective surgical procedures under general anaesthesia in Osmania General Hospital. Patients were randomly divided into two groups of 30 each. Group D received 0.6g/kg dexmedetomidine and Group F received 2 g/kg fentanyl diluted in 10 mL normal saline 10 minutes before laryngoscopy and intubation. Anaesthesia was standardised in both groups and vital parameters heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded preoperatively, during intubation and up to 10 minutes after intubation. RESULTS The groups were well matched for their demographic data. It was observed that increase in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure after intubation was highly significant in fentanyl group as compared to dexmedetomidine. There was a statistically significant difference (P <0.05) between dexmedetomidine and fentanyl groups in heart rate, systolic, diastolic blood pressure and mean arterial pressure at all time points after tracheal intubation. CONCLUSION Both the drugs attenuated the pressor response. Among the two drugs administered dexmedetomidine 0.6 µg/kg provides reliable and effective attenuation of pressor response to laryngoscopy and tracheal intubation when compared to fentanyl in a dose of 2 µg/kg.