الفهرس 
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Abstract
Summary
Laryngoscopy and tracheal intubation are mandatory for most patients undergoing surgery under general anaesthesia, which invariably is associated with certain cardiovascular changes such as tachycardia, rise in blood pressure , a wide variety of cardiac arrhythmias and transient increase in autonomic response.
This stress response should be avoided, especially in patients with cardiovascular or intracranial diseases. Various pharmacological agents have been used to attenuate the pressure responses[147].Topical and intravenous lidocaine, opioids, inhaled anesthetics, calcium channel blocker, vasodilators or beta/adrenergic blockers, magnesium sulfate, pregabalin, etc., have been tried to blunt these hemodynamic responses.
Magnesium inhibits catecholamines release from adrenal medulla and peripheral nerve endings and directly blocks catecholamines receptors and causes sympathetic block and indirectly causes dilated blood vessels and finally, reduces blood pressure [12] . Nalbuphine is an opioid drug with antagonism at μ receptor and agonism at κ receptor.
In this randomized study we tried to determine the efficacy of using intravenous magnesium sulfate versus nalbuphine on hemodynamic response to orotracheal intubation in smokers. We enrolled 80 smoker patients ASA I aged 18-50 years old , divided into two equal groups each included 40 patients, group I received magnesium sulphate 50 mg/kg preinduction , group II received nalbuphine .2 mg/kg preinduction , we compared both groups as regard BP values ( SBP,DBP,MAP) and heart rate values, both measured before induction, 3 mins after induction , 1 & 5 & 10 minutes after intubation.
We concluded that nalbuphine 0.2mg/kg statistically significant reduce arterial blood pressure( SBP & DBP) after 10 min of intubation more than magnesium sulfate 50 mg/kg in smokers and mean blood pressure after 1 minute and 10 minutes after intubation.