Background: Smooth extubation is a critical aspect of anesthesia management, particularly among patients who undergo Functional endoscopic sinus surgery (FESS), but they operate through different mechanisms. This study aimed to compare smooth extubation in patients undergoing FESS by either intratracheal dexmedetomidine or lidocaine.

Methods: Sixty patients who were undergoing FESS, were involved in this prospective double-blinded randomized controlled clinical trial, Group C received 4 ml of saline 0.9% , Group D received dexmedetomidine (0.5 μg/kg) diluted then completed to 4 ml of saline 0.9%, and Group L received 4 ml of lidocaine hydrochloride anhydrous 2%, all administrated intralumenal of ETT (Intratracheal), after 10 min after stoppage of nitroglycerin. primary outcome was achievement of smooth extubation (Hemodynamic stability, decrease cough, agitation) following FESS. secondary outcomes included evaluation of extubation time, Steward Recovery Score (SRS), drug-related side effects.

Results: Heart rates and mean blood pressure (BP) were significantly higher in group C (saline) compared to groups D (dexmedetomidine) and L (lidocaine) at all time points before and after extubation (p < 0.05). Postoperative recovery, awakening, and extubation times were significantly longer in group C compared to groups D and L (p < 0.05). Group D had more bradycardia and hypotension (30%) than group L (5%) (p < 0.05).

Conclusion: Intratracheal Dexmedetomidine and Lidocaine are both effective for attenuating extubation responses among patients undergoing functional endoscopic sinus surgery, with dexmedetomidine showing some advantages in hemodynamic (as regard prevention of hypertension and tachycardia) and extubation quality. Dexmedetomidine was more effective in attenuating cough reflex.