Abstract Study Objective To investigate the effects of stellate ganglion block (SGB) on cardiovascular response and heart rate (HR) variability in elderly patients during anesthesia induction and endotracheal intubation. Design A randomized, double-blinded, and placebo-controlled study. Setting University-affiliated teaching hospital. Participants Eighty elderly patients (American Society of Anesthesiologists grades I and II) receiving elective surgery during general anesthesia. Interventions Right stellate ganglion injection (SGB) was performed in all patients using 10 mL of 1% lidocaine or normal saline. Measurements Systolic blood pressure (BP), diastolic BP, HR, and calculated rate pressure product. HR variability at the following time points: conscious status before induction (T0 ); immediately before intubation (T1 ); immediately after intubation (T2 ); and 1, 3, and 5 minutes postintubation (T3 , T4 , and T5 ). Main Results No significant differences in BP and HR were observed between the 2 groups. Rate pressure product values significantly increased in the control group compared with baseline and SGB group values. Low-frequency power (LF) and LF/high-frequency power (HF) significantly increased, and HF and normalized units of HF significantly decreased in the control group compared with baseline values. LF, normalized units of LF, and LF/HF in the SGB group significantly decreased compared with those of the control group. Conclusion SGB protects the myocardium and effectively suppresses stress responses during anesthesia induction and tracheal intubation in elderly patients.