Laryngoscopy and intubation trigger transient hemodynamic responses, including increased heart rate, blood pressure, and myocardial oxygen demand, due to somatovisceral reflexes. While generally well-tolerated in healthy patients, these changes can be harmful in individuals with cardiovascular or cerebrovascular conditions.

To mitigate this response, various agents such as opioids, beta-blockers, calcium channel blockers, vasodilators, and lidocaine have been used via intravenous, topical, or nebulized routes. Nebulization is preferred due to its fewer side effects and effectiveness in attenuating airway irritation.

Lidocaine, a local anesthetic, is widely used in nebulized form to blunt intubation-induced cardiovascular responses. Dexmedetomidine, an alpha-2 adrenoceptor agonist with sedative and sympatholytic properties, is also being explored for nebulized administration to avoid intravenous side effects like bradycardia and hypotension.

Ultrasonic nebulization is a promising technique that produces fine aerosol particles for deeper airway penetration, requiring lower doses and reducing toxicity risks. While lidocaine nebulization is well-studied, few studies have assessed ultrasonic nebulization of dexmedetomidine. This study aims to compare the efficacy of ultrasonic nebulization of dexmedetomidine versus 4% lidocaine in attenuating the pressor response to laryngoscopy and intubation.