BACKGROUND: The primary objective of this study was to determine the effect of fentanyl, esmolol, and lidocaine on arterial blood pressure (BP) and heart rate (HR) following endotracheal intubation (ETI) and during an operation in patients with chronic renal failure (CRF) undergoing an arteriovenous fistula (AVF). METHODS: Sixty CRF patients who underwent creation of an AVF were analyzed for this study. Before ETI, the patients were randomly placed in a control group (CONT, n = 15), fentanyl group (FENT, 2micro gram/kg, n = 15), esmolol group (ESM, 1 mg/kg, n = 15), or lidocaine group (LID, 1 mg/kg, n = 15) and then each drug was administered before ETI. HR and BP were measured before intubation (baseline), after intubation, immediately after surgical incision (A-Inc), 15 min (A-Inc15) and 30 min (A-Inc30) after surgical incision. Mean arterial pressure was controlled between 20% of the pre-intubation value with the control of inspired fraction of isoflurane, and with ephedrine or clonidine. RESULTS: The HR was not different among groups. The elevation of BP following ETI in FENT was less than in CONT. BP was lower in FENT at A-Inc, A-Inc15, and A-Inc30 than in CONT, ESM, or LID. The administered dose of clonidine was not different among groups, but that of ephedrine was larger in FENT than in CONT. CONCLUSIONS: In CRF patients undergoing an AVF, esmolol 1 mg/kg and lidocaine 1 mg/kg could not prevent the elevation of BP and HR following ETI. The elevation BP after ETI was blunted by fentanyl 2micro gram/kg, but it decreased BP during the operation and increased the requirement of ephedrine. It is concluded that further studies must be made about the adminstration of a shorter acting opioid and of a larger dose of esmolol and lidocaine for preventing elevation of BR and HR in CRF patients undergoing an AVF.