Topical anesthesia of oropharynx with lidocaine aerosol (6 ml of 4% for 5 min) prevented hypertension and tachycardia during laryngoscopy and tracheal intubation. In the control group (saline aerosol), systolic and mean BP as well as heart rate (HR) significantly increased during laryngoscopy and intubation. These changes were still present after 5 min. No patient in the aerosolized lidocaine group developed any premature ventricular contraction (PVC), but 4 of 10 patients in the control group had 2 to 3 PVCs during laryngoscopy and intubation. The pressor response and tachycardia observed during laryngoscopy and tracheal intubation were, thus, successfully prevented by lidocaine aerosolization. This simple technique for oropharyngeal anesthesia before laryngoscopy intubation may be considered, particularly in patients with intracranial pathology and/or decreased myocardial reserve.