الفهرس 
Introduction
Anatomy of the larynxOnly 14 pages are availabe for public view
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Abstract
Direct laryngoscopic surgery is a common procedure to be performed either to diagnose or treat laryngeal lesions with or without the use of an operating microscope. This technique represents several challenges for anesthesiologists, usually under general anesthesia, which requires sufficient muscle relaxation and critical surgical needs for non-movement of vocal cords, as vocal cords movement, coughing or endoscopy may cause adverse results. Another is the relatively short time that requires rapid recovery of muscle power and vocal cords reflexes. Increased heart rate, high blood pressure and heart arrhythmia are severe acute sympathetic stimulation usually follow direct laryngoscopic surgery which may be serious in elderly patients living with cardiovascular disease. Cough and sore throat are frequent annoying complaints to patients, while postoperative laryngospasm is a major concern. Local anesthesia of the mucosa of the larynx or management with short opioids to relieve stress during internal surgery was described. In our study, Patients were allocated randomly into three equal groups received bilateral superior laryngeal nerve block (placebo group, lidocaine group and dexmedetomedine group). As a result of our study, patients who received bilateral SLN block in dexmedetomedine group showed significantly lower incidence and severity of postoperative sore throat and lower incidence and severity of cough just before extubation (bucking) and over the 1st 2 hrs. postoperatively.So alone dexmedetomidine significantly decreases opioid requirement and maintain hemodynamic stability throughout the surgery and postoperative period. Our study was conducted to evaluate and compare the peri-operative effects of co-administration of dexmedetomidine to lidocaine as adjuvant medications and supplements to standard general anesthesia in patients undergoing direct laryngoscopic surgery. Also, the results showed that dexmedetomidine, and lidocaine have decreased sympatho-adrenal and cardiovascular responses to anesthesia and surgery as signified by decreased HR, SBP and DBP in comparison to placebo group. These changes were significant (10 minutes after intubation, before, and after extubation). As well, amelioration of the sore throat could be represented by significant lower values in dexmedetomidine group as compared to lidocaine and placebo group at (30 minutes and 2 hours after recovery), and in the two studied groups(L and D) relative to placebo group (4 hours and 24 hours).