Introduction: The induction of anaesthesia is a critical phase that ensures a controlled and safe surgical experience. This study evaluates the comparative effects of Propofol-Fentanyl and Dexmedetomidine-Ketamine combinations on haemodynamic stability during laryngeal mask airway (LMA) insertion in adults undergoing elective surgeries. Methodology: A randomized controlled trial was conducted at the Department of Anaesthesiology, Vinayaka Mission's Medical College, Karaikal, over two years. ASA I and II patients aged 18-60 years with a BMI of 18.5-29.9 kg/m2 were recruited and randomized into two groups: Group A (Propofol-Fentanyl) and Group B (Dexmedetomidine-Ketamine). Haemodynamic parameters, ease of LMA insertion, and complications such as apnoea, coughing, swallowing reflexes, and laryngospasm were assessed. Results: The study found no significant difference in demographic variables between the two groups. Heart rate and blood pressure remained stable throughout the procedure, with Group A exhibiting higher heart rates at 15 minutes and post-operatively. Oxygen saturation levels were comparable, and both groups demonstrated similar ease of LMA insertion and incidence of complications. Conclusion: Both anaesthetic combinations are effective for LMA insertion, but Dexmedetomidine-Ketamine provides superior haemodynamic and respiratory stability, supporting its use in patients requiring tighter perioperative hemodynamic and respiratory control. © 2025 Elsevier B.V., All rights reserved.