Background Perioperative airway management of patients with difficult airways is a hot issue in clinical anesthesia. Awake fibreoptic intubation (AFOI) is the gold standard of management of the predicted difficult airway. However, it is not always easy to provide adequate sedation, analgesia for patients and ensure effective spontaneous ventilation at the same time. Certain doses of Remifentanil can inhibit the stress response of intubation. As an ideal narcotic analgesics, it has been reported for AFOI. Objective To evaluation the efficacy and safety of Remifentanil administration in the AFOI and provide evidence for its clinical application and further studies． Content The impact of different doses of remifentanil on the patients in AFOI, the advantages and disadvantages of different prescribes as well as its application in special patients were analyzed in this review. Trend Although Remifentanil has been proved to possess many advantages in AFOI, the best dosage regimen still needs further clinical studies.