Background: Globally, approximately 310 million surgeries are performed yearly, with many patients requiring endotracheal intubation to successfully conduct these procedures. Endotracheal intubation is a crucial aspect of modern anesthesia, as it provides several benefits, including maintaining the patency of the airway, preventing pulmonary aspiration, providing positive pressure ventilation, controlling the delivery of oxygen and eliminating carbon dioxide. However, stimulation of the upper respiratory tract during tracheal intubation under general anesthesia can lead to activation of the sympathoadrenal system, resulting in increased serum catecholamines. This can be a concern for patients who are at risk of developing hypertension or tachycardia. Therefore, it is important to carefully monitor the patient's vital signs and adjust the anesthesia plan as needed to minimize the risk of adverse effects. Ketamine has been used successfully to treat acute pain in intranasal form. Nebulized ketamine as an analgesic bypassing first pass metabolism and without the need for intravenous access, used to decrease the need for rescue analgesia during PACU care. Delivery of ketamine by inhalation is safe, accessible, and simple method. Advantages of this route include the possibility of ketamine administration outside the hospital setting in cases if no I.V. access line is required. Magnesium sulfate is used in anesthesia and sedation most frequently and in obstetrics. The high frequency of using magnesium attention being paid to this drug, as well as the introduction of multimodal analgesia and anesthesia techniques. Magnesium sulfate nebulization has a significant effect to attenuate the stress response to Endotracheal intubation in the form of attenuating increase of Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Heart Rate (HR), and Blood Glucose level.