Background: During functional endoscopic sinus surgery (FESS), intranasal bleeding affects operative field visibility and increases the frequency of complications. Therefore, hypotensive anesthesia is a widely used technique to improve surgical outcomes. This study aimed to compare the efficacy of propofol and dexmedetomidine infusion for hypotensive anesthesia in patients undergoing FESS.Methods: This prospective randomized trial was conducted in 80 adult patients aged between 18 and 50 years who were scheduled for FESS under general anesthesia. Patients were randomly divided into two groups: group P (n = 40) received propofol infusion of 100–200 µg/kg/min and group D (n = 40) received dexmedetomidine infusion with a loading dose of 1 µg/kg over 10 min after induction, followed by maintenance infusion of 0.4–0.8 µg/kg/h. Intraoperative blood loss, quality of the surgical field (based on the Fromme–Boezaart scale), hemodynamic control, and patient recovery were recorded. Statistical analysis was performed with SPSS software using Student’s t-test, chi-square test, and Mann–Whitney U test.Results: The mean arterial pressure and heart rate were significantly lower in group D throughout the surgery than in group P. Blood loss was significantly higher in group P (100.73 ± 18.12 ml) than in group D (85.70 ± 18.56 ml). The average number of patients with Fromme’s score 1/2/3 was comparable between the groups. Intraoperatively, only one incidence of bradycardia and hypotension was observed in group D (2.5%) compared with that in group P, which was insignificant.Conclusions: Both dexmedetomidine and propofol are efficacious and safe drugs for facilitating controlled hypotension during FESS; however, dexmedetomidine provides better hemodynamic control and is associated with lesser blood loss without any significant adverse effects.