Background: Flexible bronchoscopy has become the “gold standard" for managing the expected and unexpected difficult airway. Several drugs have been used to provide adequate sedation to optimize adequate fiberoptic intubation. Objective: To compare the sedative effects of dexmedetomidine and magnesium sulphate during awake fiberoptic nasal intubation in controlled hypertensive adults undergoing elective surgeries. Patients and methods: Sixty controlled hypertensive patients intubated using awake fiberoptic. They were divided into 2 equal groups: Patients received dexmedetomidine infusion at dose of 1ug/kg, and the other patients received magnesium sulphate at dose of 30mg/kg. Topicalization of airway was done using lidocaine “spray as you go technique". After completing the loading dose, Ramsay score was assessed before intubation. The 2 groups were compared according to Ramsay score, cough score, facial grimace and hemodynamic changes. This study was done at Al-Azhar University Hospitals after approval of the medical ethical committee, from May 2019 till November 2020. Results: Ramsay score, cough score and facial grimace were favorable with less hemodynamic effects in dexmedetomidine group than magnesium group. Conclusion: Dexmedetomidine was effective sedative agent for awake fiberoptic intubation in controlled hypertensive patients in comparison with magnesium sulphate.