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Resumen Objetivos Comparar la eficacia y seguridad del fentanilo con remifentanilo en la prevencion de la respuesta hemodinamica asociada a la laringoscopia directa e intubacion orotraqueal, y su repercusion sobre la saturacion periferica de oxigeno en mujeres normotensas programadas para cirugia ginecologica. Material y metodo Estudio clinico prospectivo en pacientes ASA I-II sometidas a cirugia ginecologica. Se distribuyeron de forma aleatoria en dos grupos: grupo R, remifentanilo 1 μg Kg −1 min −1 hasta la intubacion y grupo F, fentanilo 2 μg Kg −1 . Para la induccion anestesica utilizamos etomidato (0,3 mg Kg −1 ) y bromuro de rocuronio (0,6 mg Kg −1 ). Se realizaron siete mediciones seriadas de la presion arterial sistolica, diastolica y media, frecuencia cardiaca y saturacion periferica de oxigeno durante los periodos: control, desnitrogenacion, postinduccion, postintubacion y posteriormente cada dos minutos tres determinaciones consecutivas. Resultados Se incluyeron 54 pacientes. El grupo R mostro un efecto estadisticamente significativo de atenuacion de la respuesta hemodinamica postintubacion tanto en la presion arterial (p = 0,0001), como en la frecuencia cardiaca (p = 0,031) respecto de su valor basal. Sin embargo, con el grupo del fentanilo (grupo F), no se observo dicho efecto protector. No se observaron diferencias en la saturacion periferica de oxigeno en ambos grupos durante el estudio. Conclusiones A las dosis utilizadas, el remifentanilo comparativamente con el fentanilo, ofrece mayor control hemodinamico. No se observaron efectos secundarios en ambos grupos atribuibles a los opiaceos.

To compare the efficacy and safety of fentanyl and remifentanil in the prevention of hemodynamic responses to direct laryngoscopy and orotracheal intubation, and to compare the effects of these techniques on peripheral blood oxyhemoglobin saturation in normotensive women undergoing scheduled gynecologic surgery.Prospective clinical trial in ASA 1-2 patients undergoing gynecologic surgery. The patients were randomized to 2 groups: the remifentanil group received a perfusion of 1 microg x kg(-1) x min(-1) until intubation whereas the fentanyl group received a bolus dose of 2 microg x kg(-1). Etomidate (0.3 mg x kg(-1)) and rocuronium bromide (0.6 mg x kg(-1)) were used for anesthetic induction. Seven serial measurements of systolic, diastolic, and mean arterial pressure were recorded in addition to heart rate and peripheral blood oxyhemoglobin saturation at the following times: baseline, denitrogenation, postinduction, and 3 more times at consecutive 2-minute intervals.Fifty-four patients were enrolled. A statistically significant attenuation of the postintubation hemodynamic response was observed in the remifentanil group. The effect was evident on arterial pressure (P=.0001) and heart rate (P=.031) with respect to baseline values. That protective effect was not seen in the fentanyl group. No differences in peripheral blood oxyhemoglobin saturation were observed.Remifentanil provides greater hemodynamic control than fentanyl at the doses utilized. No adverse effects attributable to these opioids were observed in either group.