Introduction: Several drugs have been used to enhance patient comfort during awake nasal fibreoptic intubation (AFOI) process. Most of these can cause dangerous airway or haemodynamic compromise. This study compared combination of midazolam and fentanyl against dexmedetomidine. Methods: Thirty two adults undergoing AFOI were randomly allocated into group MF (1mg midazolam and 1 ìg/kg fentanyl) or group D (dexmedetomidine 1ìg/kg over 10 minutes). Following standard airway topicalisation technique, the study drugs were administered and AFOI was performed. Results: The demographic data, patient comfort score, post intubation score, endoscopy and intubation times were comparable. The endoscopy was observed to be easy in all patients except 2 in MF group while intubation was easy in all (group D) versus 12 patients in group MF (P value 0.03). Significant haemodynamic response was observed in group MF while patients were more stable in group D. Postoperatively, 10 and two patients in groups D and MF respectively felt sedation was excellent (P value 0.02) while increased need for sedation was felt by one and three patients in groups D and MF respectively (P value 0.028). AFOI was remembered by six and one patients in groups D and MF respectively (P value 0.003). Two in group D and three in group MF had moderate discomfort. None experienced severe discomfort. The overall satisfaction score was comparable. There were no serious adverse events during the study. Conclusions: Dexmedetomidine provides better intubating conditions and patient satisfaction without adversely affecting the airway or haemodynamic stability during AFOI.