Fourth, when patients are not fully paralyzed or rendered completely unresponsive to airway manipulations, there is an increased incidence of gagging and vomiting, which increases intra-abdominal pressure and may result in aspiration of gastric fluid. Effect of remifentanil vs neuromuscular blockers during rapid sequence intubation on successful intubation without major complications among patients at risk of aspiration: a randomized clinical trial. Comment & Response B To the Editor b Although we agree with the conclusion that use of remifentanil is inferior to neuromuscular blocking agents, we have some concerns about the recent study[1] that examined whether patients at risk of aspiration could safely undergo intubation without use of neuromuscular blocking agents. [Extracted from the article]