Abstract: Objective To investigate the effect of lidocaine ultrasonic nebulization inhalation combined with compound lidocaine cream double lumen tube coating on hemodynamics during double lumen bronchial tube intubation and extubation.Methods A total of 120 patients who underwent selective thoracoscopic lobectomy at the second Affiliated Hospital of Xuzhou Medical University were randomly divided into 3 groups:saline nebulization group (Group N), lidocaine nebulization group (Group L), lidocaine spray inhalation combined with lidocaine cream group (Group LL), with 40 patients in each group. The N group nebulized 10 ml of saline 30 minutes before anesthesia, the L group nebulized 10 ml of 2% lidocaine 30 minutes before anesthesia, and the LL group nebulized lidocaine 30 minutes before anesthesia, and lidocaine cream was applied to the front end of the double-lumen tube.The mean arterial pressure (MAP) and heart rate (HR) were recorded at various time points:before intubation (T0), immediately after intubation (T1), 1 minute after intubation (T2), 3 minutes after intubation (T3), at the end of surgery (T4), immediately after tracheal extubation (T5), 1 minute after extubation (T6), and 3 minutes after extubation (T7). Cough score and pharyngeal pain score as well as other adverse reactions were recorded during tracheal extubation.Results Compared with the N group, the MAP and HR of the L and LL groups were significantly reduced at time points T1 and T2 (P<0.017), while there was no statistical difference between the L and LL groups (P>0.017). Compared with the N and L groups, the LL group showed a significant decrease in MAP and HR at the T5 and T6 time points (P<0.017), while there was no statistical difference between the N and L groups (P>0.017).The cough and pharyngeal pain scores in the LL group were lower than those in the N and L groups (P<0.017), with no statistically significant difference in cough and pharyngeal pain scores between the N and L groups (P>0.017).Conclusions Lidocaine ultrasonic nebulization combined with lidocaine cream coating can reduce hemodynamic fluctuations during double lumen bronchial tube intubation and extubating, decrease the incidence of postoperative cough and pharyngodynia, enhance patient comfort during anesthesia, and do not increase the risk of postoperative reflux aspiration.