Objective To explore the anesthetic effect of sevoffurane combined with dexmedetomidine in pediatric cleft lip and palate surgery. Methods A total of 100 children who underwent cleft lip and palate repair surgery in our hospital from January 2023 to October 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 50 children in each group. The control group was anesthetized with sevoffurane alone, and the observation group was anesthetized with sevoffurane combined with dexmedetomidine. The perioperative hemodynamic indicators, recovery quality and adverse reaction rate were compared between the two groups. Results The HR and MAP of the observation group at T1, T2, T3 and T4 were lower than those of the control group (P<0.05). The Ramsay sedation score of the observation group was higher than that of the control group, and the PAED score was lower than that of the control group (P<0.05). The incidence of adverse reactions in the observation group (6.00%) was lower than that in the control group (22.00%) (P<0.05). Conclusion The anesthetic effect of sevoffurane combined with dexmedetomidine in pediatric cleft lip and palate surgery is superior to that of sevoffurane alone, which can stabilize perioperative hemodynamics, improve recovery quality and reduce the incidence of adverse reactions.