Background: Coughing during awakening from general Anesthesia can compromise the outcome of undergoing eye surgery.

Objectives: To evaluate and compare the effectiveness and safety of administering intratracheal lidocaine or dexmedetomidine to patients undergoing eye surgery.

Methods: In this prospective, randomized, double-blinded, controlled trial, 120 American Society of Anesthesiologists (ASA) I and II patients were scheduled for elective keratoplasty and retinal detachment surgery under general Anesthesia. The patients' ages ranged from 18 to 60 of either sex. They were randomly divided into three groups, the medication sprayed to patients via their intratracheal tubes, 40 patients in each group: Group D: Received (0.5 μg/kg) of dexmedetomidine diluted in 5 ml saline, Group L: Received (5ml) 2% of lidocaine and Group C: Received 5ml saline. The frequency of coughing in the three groups was the primary finding. The secondary outcomes were awareness time, extubation time, IOP, hemodynamic changes, surgeon satisfaction, and any complications.

Results: Compared with Group C, the cough was significantly reduced in both groups D and L (P≤ 0.0001) with a significant increase in cough grade 0 in group D when compared with group L (P≤ 0.036). The surgeons in groups D and L reported higher satisfaction levels than those in group C. Additionally, intratracheal dexmedetomidine and lidocaine treatment enhanced hemodynamic stability and maintained the IOP without causing any noticeable side effects.

Conclusions: Intratracheal dexmedetomidine reduced the cough reflex more effectively than lidocaine. However, they both contributed to a smooth extubation and a balanced anesthetic recovery following eye surgery.