Objective To analyze the effect of dexmedetomidine combined with remifentanil and propofol on emergence agitation in patients undergoing maxillofacial plastic surgery. Methods A total of 100 patients undergoing maxillofacial plastic surgery in General Hospital of Ningxia Medical University from January 2023 to August 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 50 patients in each group. The control group was given midazolam combined with remifentanil and propofol, and the observation group was given dexmedetomidine combined with remifentanil and propofol. The emergence agitation, hemodynamic indicators, stress response indicators and anesthesia recovery indicators were compared between the two groups. Results The Riker agitation scores and agitation incidence in the observation group at T1 and T2 were lower than those in the control group (P <0.05). The MAP and HR in the observation group at T1 and T2 were lower than those in the control group (P <0.05). The levels of COR and GLU in the observation group at T1 and T2 were lower than those in the control group (P <0.05). There was no statistically significant difference in awakening time and extubation time between the two groups (P >0.05). The Ramsay sedation score in the observation group was higher than that in the control group (P <0.05). Conclusion In the anesthetic management of maxillofacial plastic surgery, the combination of dexmedetomidine, remifentanil and propofol can reduce the degree of emergence agitation after general anesthesia, maintain the stability of hemodynamic indicators during surgery and extubation, inhibit the increase of cortisol and blood glucose caused by stress response, and obtain a more ideal sedation effect without prolonging the awakening time, thereby overall optimizing the anesthesia recovery-related indicators.