[Disclaimer: I'm not in clinical yet, the only things that can be hurt at this point are my pride and SIM man ]

The plan is to do GA on a obese pt/ having a lap chole. She has significant resp problems as well (big time smoker), plus she has GERD. We want to use remifentanil for perioperative pain control (along with sevo). We are going to do a RSI and want to give some opiod before hand to help blunt the sympathetic response and basically make things go smoother.

Question: do you give a different opioid before induction or do you just start the remi then, how do you normally handle this?

Thanks for any suggestions!