AIM: This study aims at comparing the impact of Magnesium Sulfate and Lidocaine sprays on hemodynamic changes after laryngoscopy and tracheal intubation. DESIGN: This double-blind clinical trial (code IRCT20230719058846N1) was conducted on the patients undergoing elective surgery in the city of Karaj. METHODS: A total of 100 patients, aged 18 to 40 years and classified as ASA I or II, who were candidates for elective surgery, were randomly assigned to two equal groups. Prior to intubation, patients received lidocaine spray (5 puffs of Lidocaine 10%) in one group, and magnesium sulfate spray (5 puffs of Magnesium 20%) in the other. Induction of anesthesia was the same in both groups. Patients' hemodynamic statuses were measured and compared once before the intubation and also 1, 3, 5, 7 and 10 min after it. RESULTS: Before the intervention, there was no statistically significant difference between the two groups in terms of demographic and hemodynamic variables (P <
0.05). The results showed that the systolic blood pressure at minutes 3, 5, and 7 was significantly lower among the patients receiving magnesium than those receiving lidocaine (P <
0.05). Other hemodynamic variables were not statistically different between the two groups (P <
0.05). CONCLUSION: Based on the findings of the present study, magnesium sulfate spray is more effective than lidocaine in controlling hemodynamic complications. Therefore, it can be used to reduce hemodynamic complications following intubation. However, it may be associated with tachycardia, which needs to be taken into account.