Objective To compare the hemodynamic responses to orotracheal intubation with a Shikani Optical Stylet (SOS) using left molar approach，median approach and right approach. Method 92 patients ASA physical status Ⅰ-Ⅱ，aged 20-65 years，scheduled for elective surgery under general anesthesia requiring orotracheal intubation were randomly allocated to the SOS group by the left molar approach (SL group)，the median approach (SM group) or the right molar approach (SR group). After an intravenous anesthetic induction，the orotracheal intubation was performed using a SOS. Invasive blood pressure and HR were recorded before and after anesthetic induction，immediately after intubation and 5 minutes after intubation with 1-minute interval and the intubation time was also noted. Rate-pressure product (RPP) were calculated. Results As compared with SL group，the time to successful intubation in SR group is significantly longer. After anesthetic induction，blood pressures and RPP in the three groups decreased significantly compared to their preinduction values. As comparison with their postinduc-tion values，the orotracheal intubation in the three groups caused significant increases in BPs, HRs and RPP. HRs of three groups after intubation were significantly higher than their baseline values，and increase in HR lasted for 1-3 min. As compared with SL group，SBP immediately after intubation was significantly higher in SR group. As compared with group，SBP、DBP and MAP immediately after intubation in SR group was significantly higher. The incidences of SBP and HR more than 130% of baseline value are 16.7% and 46.7% in SL group，10% and 50% in SM group，16.7% and 33.3% in SR group. The incidences of SBP more than 130% of baseline value and RPP more than 22 000 were not significantly differently. The occurrence time of SBP and HR maximum after intubation beginning and intubation completion were not significant between three groups. Con-clusion The intubation time in SR group is shortest in three group. The orotracheal in-tubation with SOS by the left molar approach and the median approach provide similar hemodynamic responses, orotracheal intubation with SOS by the right molar approach provide more severe hemodynamic responses.