Background: The response of stress to intubation and laryngoscopy among patients undergoing different types of surgeries could occur because of the ejection of endogenous catecholamines. The current study aimed to attenuate the stress response to intubation and laryngoscopy among cases receiving elective surgeries employing either nebulized ketamine or magnesium sulfate.

Methods: This double-blinded prospective randomized controlled clinical trial was conducted on 63 cases who were arbitrarily divided into 3 groups (n=21 in each), Group C (Control): nebulized using normal saline. Group K (Ketamine): nebulized using ketamine.

Results: Intraoperative HR, SBP, DBP, and MAP at 3, 5, 8 and 10 minutes post-intubation among group C increased significantly compared to group K, M (P<0.0001), group K showed substantial increase compared to group M (P<0.01), also Regrading postoperative HR, SBP and DBP they increased significantly at 15 and 30 min in group C compared to K and M (P<0.001) while MAP showed notable increase at 15 and 30 min in groups C and K compared to group M (P<0.01). Blood cortisol level increased significantly at 10 min after intubation in groups C and K compared to group M (P<0.000) and in group C compared to K (P<0.000).

Conclusion: Both interventions were found to significantly blunt the increases in HR, SBP, DBP, MAP, blood cortisol level, and blood glucose level. However, Magnesium sulfate could be more effective in blunting stress response than ketamine. Also, mg sulfate decreased the incidence of postoperative sore throat more than ketamine.