OBJECTIVE The present study compared the efficacy of esmolol and dexmedetomidine for attenuation of the sympathomimetic response to laryngoscopy and intubation in elective neurosurgical patients. METHODS A total of 90 patients aged 20-60 years, American Society of Anesthesiologists physical status I or II, either sex, scheduled for elective neurosurgical procedures were included in this study. Patients were randomly allocated to three equal groups of 30 each comprising of Control group (group C) 20 ml 0.9% saline intravenous (IV), group dexmedetomidine (group D) 1 μg/kg diluted with 0.9% saline to 20 ml IV and group esmolol (group E) 1.5 mg/kg diluted with 0.9% saline to 20 ml IV. All the drugs were infused over a period of 10 min and after 2 min induction of anesthesia done. Heart rate (HR), systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded baseline, after study drug administration, after induction and 1, 2, 3, 5, 10, and 15 min after orotracheal intubation. RESULTS In group D, there was no statistically significant increase in HR and blood pressure after intubation at any time intervals, whereas in group E, there was a statistical significant increase in blood pressure after intubation at 1, 2, and 3 min only and HR up to 5 min. CONCLUSIONS Dexmedetomidine 1 μg/kg is more effective than esmolol for attenuating the hemodynamic response to laryngoscopy and intubation in elective neurosurgical patients.