Intubation with endotracheal tube during general anaesthesia is a fairly common practice in general anaesthesia. Physiological responses are common during anesthesia emergence and endotracheal extubation, causing complications including cough, laryngospasm, bronchospasm, and tachycardia. Studies have shown improvement in post extubation cough with IV Dexmedetomidine but it can have systemic side effects like bradycardia and hypotension. Literature search did not reveal any studies determining the effect of intra tracheal dexmedetomidine on post extubation cough especially in the Indian setting which is why we aim to study the effect of intra tracheal dexmedetomidine on post extubation cough to bypass the systemic side effects. After taking ethical clearance and meeting inclusion and exclusion criteria, patients will be divided into two groups as per computer generated randomisation table.

Group A: Will receive 0.3 mcg per kg of intratracheal dexmedetomidine diluted to 2 ml of normal saline
Group B: Will receive 2 ml of plain normal saline

After a thorough pre operative evaluation, the patient is shifted to recovery and a functional 18G or 20G cannula is secured.
Nil by mouth status of the patient is confirmed and the patient is shifted to the operation theatre.
Intraoperatively, monitors will be attached and pre operative vitals will be registered.
Intraoperative hemodynamic parameters will be monitored.
The patient will be premedicated with injection glycopyrrolate 0.005 mg per kg, injection midazolam 0.05 mg per kg, and injection fentanyl 2 mcg per kg.
The patient will be induced with injection propofol 2 mg per kg and injection suxamethonium 2 mg per kg.
The patient will be intubated with an appropriate size endotracheal tube.
After intubation, the cuff will be inflated with an adequate amount of air to prevent leak. Intra cuff pressure will be checked immediately after intubation and then every 30 minutes till end of surgery. The pressure will be maintained at less than 30 cm of water.

In Group A, the patient will be administered dexmedetomidine 0.3 mcg per kg intratracheally using a tuberculin syringe (diluted to 2 ml with normal saline to ensure adequate entry into the trachea) via the endotracheal tube 10 minutes after intubation.
In Group B, the patient will receive 2 ml of normal saline intratracheally.

Following extubation, the incidence and severity of cough will be assessed using a 4 point cough score:
Cough score 0 - No cough
Cough score 1 - Mild cough (single cough)
Cough score 2 - Moderate cough (more than one episode of unsustained cough for less than or equal to 5 seconds)
Cough score 3 - Severe cough (sustained bouts of coughing for more than 5 seconds)

Cough will be assessed at the following times:

• Immediately after extubation

• Every hour till the first 6 hours

• Every 4 hours till 24 hours

In case of severe cough, the patient will be given antitussive syrup or lozenges on request.