Endotracheal intubation is an essential and important procedure. However, in some conditions such as the presence of difficult intubation, there are some limitations for endotracheal intubation with muscle relaxation. Objective: To compare the effect of propofol-alfentanil with ketamine-alfentanil on endotracheal intubation without muscle relaxation Methods: This was a double-blind clinical trial carried out on 60 patients aged between 18-50 years old. The patients were within the ASA class

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... of anesthesia chosen for elective surgery at Shahid Rajaei Hospital in Qazvin, Iran. The participants were randomly divided into 2 equal groups. For endotracheal intubation without muscle relaxation, one group received propofol-alfentanil and another group ketamine-alfentanil. Changes in hemodynamic parameters (heart rate and blood pressure) and physical findings (vocal cord position, jaw relaxation, ability of mask ventilation, and reaction to endotracheal intubation) were compared between two groups. Data were analyzed with SPSS software using statistical tests including t-test and Chi-square test. Findings: Regarding the hemodynamic parameters, there was significant difference between two groups so that in ketamine group the hemodynamic conditions were more stable than in propofol group (P<0.05). With respect to the physical findings, 93.3% of patients in propofol group were in excellent class and 6.7% in good class whereas in ketamine group 40% were in excellent class, 33.3% in good class, and 26.7% in poor class. Statistically, there was significant difference between two groups (P<0.05). Conclusion: According to our findings, it seems that the propofol-alfentanil to produce better conditions than the ketamine-alfentanil when performing endotracheal intubation without muscle relaxation.