Endotracheal intubation (ETT) can cause emergence phenomena (EP) including coughing, sore throat, and dysphonia. Two methods used to prevent EP are the administration of local anesthetics directly onto airway structures using a specialized laryngotracheal instillation of topical anesthesia (LITA) tube (Sheridan Catheter Corporation, Argyle, New York) or the placement of a local anesthetic into the ETT cuff. The purpose of this study was to determine which method was better at preventing ERl In this prospective, randomized, comparative analysis, a sample of 160 ASA class I through III patients were randomly assigned to receive their EP prophylaxes either by placement of alkalinized lidocaine directly into the ETT cuff at intubation or by injection into a specialized port on the LITA tube approximately 30 minutes before extubation. Variables measured included the incidence and severity of sore throat, coughing, and dysphonia for the first 24 hours following surgery. The incidence of cough and sore throat was higher in the LITA group, achieving significance in the postanesthesia care unit and after discharge to home. No difference in any of the other variables was noted between groups. Our study demonstrated greater efficacy in decreasing the incidence and severity of EP by placing an alkalinized solution of lidocaine into the ETT cuff on intubation.