Skull pin insertion during craniotomies is a brief, intensely stimulating, painful stimuli
occurring during the conduct of a neurosurgical or spine anesthetic. Remifentanil is an ultra
short acting opioid that has been successfully used to blunt hemodynamic responses in a wide
variety of clinical scenarios. It is our intention to ascertain the optimal dose for blunting
the hemodynamic response to skull pin insertion using remifentanil.