Fentanyl is regularly used in clinical anesthesia practice but fentanyl-induced cough (FIC) will sometimes bother anesthesiologists. This study was designed to examine the effect of intravenous (IV) dexamethasone (DEX) on FIC. Methods: Eighty ASA class I–II patients, aged 18-80 years and weighing 40-90 kg, scheduled for elective surgery were given DEX to reduce FIC. One hundred and eight patients from our previous study database on FIC, after excluding smokers, comprised the reference group. All patients were given fentanyl (100 μg for 40–69 kg and 150 μg for 70–90 kg for clinical convenience) over 2 seconds via the proximal port of a peripheral IV line in the forearm. Patients in the treatment group received DEX (10 mg, IV) 5 minutes prior to fentanyl injection, while those in the reference group received fentanyl injection only without any premedicant. We recorded the number of coughs of each patient for 30 seconds after fentanyl injection. Results: The incidence of cough was 6.3% in the DEX group and 21.3% in the control group, respectively (p = 0.008). However, the severity of cough observed was not significantly different by DEX pretreatment (p>0.05) or hemodynamic profiles. Conclusion: DEX (10 mg, IV) 5 minutes prior to fentanyl injection reduces the incidence of FIC and can be an ideal premedicant for general anesthesia induction.