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Background: We performed a prospective, randomized, and controlled trial to evaluate the effect of an intravenous fentanyl and propofol on the variation in BIS level associated tracheal suction. Methods: Thirty ICU patients intubated or tracheostomized were randomly allocated to control and experimental groups. Control group was received saline and experimental groups were received propofol with or without fentanyl intravenously prior to tracheal suction. And then we monitored BIS index, blood pressure, heart rate and SpO2 before, during and after tracheal suction. Results: BIS index was significantly lower in propofol plus fentanyl group than others during experiment (P < 0.05). Heart rate and blood pressure in propofol plus fentanyl group also less increased than those in control or propofol group during tracheal suction (P < 0.05). Conclusions: These results suggest that co-administration of propofol and fentanyl has more effective than propofol alone in sedation and analgesia of ICU patients during tracheal suction. (Korean J Anesthesiol 2007; 52: 156~60)