Patients undergoing surgical procedures that require deep relaxation for long periods of time are best suited for general anesthesia if there are no contraindications. Surgeries that cannot be adequately anesthetized with local or regional anesthesia require general anesthesia. Operations likely to result in significant blood loss or in which breathing will be affected necessitate general anesthesia. Uncooperative patients are also better treated with general anesthesia, even for more minor procedures. Patient preference can also influence the decision to undergo anesthesia. The advancement of the endotracheal tube has closely followed advancements in anesthesia and surgery. Modifications and minimize aspiration, isolate the lung, administer medications, and prevent airway fires. Despite advances with the endotracheal tube, more research to optimize its use is necessary. Laryngoscopy and tracheal intubation are potent stimulators of the sympathetic and parasympathetic nervous systems, with variable and sometimes unpredictable responses. Hemodynamic response is characterized by a sudden surge in mean arterial pressure (MAP) and heart rate (HR), arising within 30 seconds following direct laryngoscopy and endotracheal intubation, approaching baseline in about 10 minutes. A rate pressure product (RPP) more than 11000 has been associated with signs of myocardial ischemia in patients with coronary artery disease. Laryngoscopy and intubation can lead to an average increase in blood pressure of 40 to 50%, and a 20% increase in heart rate. Sudden increase in blood pressure may cause rupture of aortic / cerebral aneurysm, imbalance of myocardial oxygen supply and demand, increase cerebral blood flow due to increased cerebral metabolic activity and systemic cardiovascular effects, and dysrhythmias. When the stress response during laryngoscopy without intubation was compared among Macintosh, Miller and McCoy laryngoscopes, the maximum response was obtained with the use of Miller and minimum response with the McCoy laryngoscope. The tip of the Miller’s blade which is inserted posterior to the epiglottis stimulating the vagus, causes maximum response. The stress response to laryngoscopy appears to be less marked with the McCoy blade probably due to a reduction in the force necessary to obtain a clear view of the larynx.