After confirming eligibility, written informed consent will be obtained by a trained team member who is not involved in assigning treatment or giving the study medication. Each participant will receive a unique study number to protect privacy. Participants will be randomly assigned to receive one of the study medications using a chance-based method.The study medication will be administered through a vein before placement of the breathing tube. Blood pressure and pulse rate will be measured before the procedure and at several time points after the breathing tube is inserted.

After confirming eligibility, written informed consent will be obtained and each participant will be assigned a unique study ID to maintain confidentiality. Participants will be randomly allocated using a computer-generated random sequence implemented through the lottery method, with assignments placed in sealed opaque envelopes opened on the day of surgery. The study medication will be administered intravenously according to the study protocol before laryngoscopy and endotracheal intubation. Mean arterial pressure and heart rate will be recorded at baseline and at 1, 3, 5, and 10 minutes after intubation. Demographic information and study-related observations will be documented in a structured data collection form.

Inclusion Criteria:

American Society of Anesthesiologists (ASA) physical status III-IV. Patients who are at risk of cardiovascular events

Exclusion Criteria:

1. Patients with known hypersensitivity to dexmedetomidine and Lignocaine.
2. Patients on medications that could interfere with the study (e.g., beta-blockers, calcium channel blockers).
3. Pregnant or lactating women.
4. Patients with a history of airway anomalies or difficult intubation.

Hospital Ethical Committee doesnt allow