Endotracheal intubation is a critical component of general anesthesia but is often associated with significant stress responses, including hemodynamic fluctuations and increased sympathetic activity. Such stress responses can negatively impact surgical outcomes, particularly in procedures like Functional Endoscopic Sinus Surgery (FESS), where a clear surgical field is essential. Melatonin, a naturally occurring hormone with sedative, anxiolytic, and antioxidant properties, has emerged as a promising pharmacological agent for mitigating these stress responses. This review explores the efficacy of oral melatonin in attenuating hemodynamic changes associated with endotracheal intubation and its role in optimizing the surgical field during FESS. The literature highlights melatonin's potential to blunt the cardiovascular stress response by reducing heart rate, blood pressure, and catecholamine levels during intubation. Additionally, its ability to reduce oxidative stress and inflammatory mediators may contribute to improved tissue perfusion and reduced bleeding, thereby enhancing the surgical field. The safety profile of melatonin, combined with its ease of administration and low cost, further underscores its utility in perioperative settings. This review synthesizes findings from clinical trials, meta-analyses, and experimental studies to evaluate the mechanisms, efficacy, and clinical implications of oral melatonin administration in FESS patients. By addressing gaps in current anesthetic protocols, melatonin could serve as a valuable adjunct to conventional pharmacological strategies, improving patient outcomes and surgical efficiency. Future research should focus on standardizing dosages, timing, and administration protocols to maximize its clinical benefits.