| IntroductionIdeal anaesthetic analgesic drugs have always been one aim in the process of new drug studies and developments. Remifentanil is a new receptor agonist with a rapid onset and short duration and it's context - sensitive half - time is about three minutes. The propanoic methyl ester linkage in the remifentanil structure is susceptible to hydrolysis by non - specific issue and plasma esterases and not depend on liver's or renal functions. Acording to anaesthesia deepeness and surgery requirement we can adjust remifentanil' s administrating dose and speed. Remifentanil slightly influence on hemodynamics but can significantly depress cardiovascular response to operation and intubation. Therefore,remifentanil have widely been applied in all varieties of operations such as heart surgery, general surgery, gynecologic surgery et al. Meanwhile, in the field of patient - controlled sedation and post - operative analgia and outpatient surgery have maken a great progress.The use of propofol and adjuvants such as short - acting opioids, adrenergic blockers and local anaesthetic agents may provide adequate conditions for laryn-goscopy and tracheal intubation without the need for neuromuscular blocking a-gents. Tachycardia, hypertension, arrhythmias, and myocardial ischaemia caused by laryngoscopy and tracheal intubation in susceptible individul may be attenuated by i. v. opioid. Previous work in premedicated adults showed that tracheal intubation was successful after induction of anaesthesia with fentanyl and propofol and conditions were similar to those achieved with thiopental and succi-nylcholine. Given the pharmacokinetic profile of remifentanil, it was hypothe-sized that it may also be useful in facilitating tracheal intubation.After a short pilot study, we designed a prospective, randomized, double -blind study to assess intubating conditions and haemodynamic changes in two groups of remifentanil and fentanyLMaterials and Methods1. Patient and MaterialsIncluding criteria: ASA I - II grade patients undergoing elective impatient surgery patient and aging from eighteen to sixty - five year old.Excluding criteria: Patients whose physical characteristics suggested difficulties in intubation (modified Mallampati score ID or IV) and those who had a previously documented failed intubation. Patients with a history of upper gastrointestinal reflux and a history of reactive airways disease and be hypersensitive to opioid. Patients who underwent more than two minutes during trachea! mtaba-tion.Materials: Non - invasive blood pressure and pulse - oxygen saturation mo-nitor - meter ( Datex - Ohmeda ) , laryngoscopy, anaesthesia mask, tracheal tube, anaesthetic machine ( Datex - Ohmeda).2 MethodsFifty ASA physical status I - II patients were randomly allocated into two groups. All patients were premedicated with luminal 0. Igram and scopolamine 0. 3 mg approximately 1 h before anaesthesia. The patients in group I were induced with remifentanil 2g kg-1 and propofol 2mg kg-1 . The group II was induced with fentanyl 3g kg-1 and propofol 2mg kg-1. Assignment to each group was opened and the remifentanil solution was diluted to a volume of 10 ml with 0. 9% saline by anaesthetist No. 1. When the patient lost consciousness, which was judged by loss of response to command and loss of eyelash reflex, ventilation via a mask was attempted by anaesthetist No. 2. Ease of ventilation was recorded as ease, difficult or impossible.Two minutes after induction, tracheal intubation was performed. Mean arte-rial blood pressure(MAP) and heart rate (HR)and RPP(SBPxHR) were recorded before anaestheia induction (baseline) and two minutes after induction and five minutes after tracheal intubation. Tracheal intubating conditions weregraded by anaesthetist No. 2 who unknew specific inducing medicine according to ease of laryngoscopy, position of the vocal cords, coughing, jaw relaxation and movement of the limbs. Intubating conditions were judged as acceptable when all scores were 2 or less. If any o...
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