Background: The effects of ProSeal laryngeal mask airway (PLMA) removal and tracheal extubationon cardiovascular responses were studied in elderly hypertensive type-2 diabetic patients in a randomize ddouble-blind study. Methods: A total of 60 elderly controlled type-2 diabetic hypertensive American Society of Anesthesiologists II & III patients were randomly allocated to two groups (n-30 of each) for PLMA insertion or endotracheal intubation. A standardized anesthetic sequence was used for induction and maintenance of anesthesia. The two groupswere then compared for haemodynamic changes at the time of extubation/PLMA removal. Results: In PLMA group, heart rate increased during PLMA removal butremained elevated for only 3 minutes while mean arterial pressure remained elevated for only 2 minutes. The elevations of heart rate and mean arterial pressure were exaggerated in the extubation group and persisted for more than 5 minutes. No complication was observed in any patient and no difficulty was encountered in insertion of PLMA in any patient. Conclusion: Elderly hypertensive diabetic patients are at risk of exaggerated press or response at the time of extubation. PLMA removal is associated with fewer hemodynamic changes than tracheal extubation and should be preferred wherever possible.