Laryngoscopy and endotracheal intubation are associated with significant sympathetic stimulation resulting in transient increases in heart rate and blood pressure, which may be harmful in susceptible patients. Various pharmacological agents are used to attenuate this hemodynamic response. Remifentanil, an ultra-short acting opioid, has been shown to be effective for this purpose; however, the optimal dose that provides adequate attenuation with minimal adverse effects remains uncertain.

This prospective, open-label study will be conducted at a tertiary care hospital to evaluate and compare the effects of different doses of intravenous remifentanil on the hemodynamic response to endotracheal intubation in adult patients undergoing elective surgery under general anesthesia. Participants will be allocated into four groups: a control group receiving standard induction without remifentanil, and three intervention groups receiving remifentanil at doses of 1 µg/kg, 1.5 µg/kg, and 2 µg/kg, respectively, during induction of anesthesia. Hemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure will be recorded at baseline, during laryngoscopy, and at predetermined intervals following endotracheal intubation. The study aims to identify the dose of remifentanil that most effectively attenuates the hemodynamic response to intubation with minimal adverse effects.