Background: The stress response to laryngoscopy and endotracheal intubation is a significant concern for anesthesiologists. Various medications have been used to attenuate this response, but none have achieved full effectiveness. Objective: To compare the effects of intravenous dexmedetomidine and fentanyl on hemodynamic responses to laryngoscopy and endotracheal intubation and following formation of pneumoperitoneum in laparoscopic elective abdominal surgeries under general anesthesia. Methodology: This prospective, double-blind, randomized comparative study was conducted on 100 patients undergoing laparoscopic abdominal surgeries under general anesthesia. Patients were randomly allocated into two groups: Group 1 (dexmedetomidine) and Group 2 (fentanyl). Hemodynamic parameters, including heart rate, mean arterial pressure (MAP), and oxygen saturation (SpO2), were recorded at various time intervals. Results: The study found significant differences in heart rate and MAP responses between the two groups at various time intervals during surgery. Dexmedetomidine was more effective in attenuating the pressor response compared to fentanyl. The mean heart rate and MAP values were higher in Group 1 (dexmedetomidine) at pre-operative and intra-operative baseline, but decreased significantly after pneumoperitoneum. In contrast, Group 2 (fentanyl) showed an increase in mean heart rate and MAP values after pneumoperitoneum. Conclusion: The study concludes that dexmedetomidine is a more effective medication than fentanyl in attenuating the hemodynamic responses to laryngoscopy and endotracheal intubation and following formation of pneumoperitoneum in laparoscopic elective abdominal surgeries under general anesthesia. Dexmedetomidine maintains a stable heart rate and MAP, unlike fentanyl, which makes it a preferred choice for patients undergoing laparoscopic surgeries.