Funding information Expenses in the trial were covered by departmental sources and covered salary for study investigators.

Background To facilitate tracheal intubation, either a neuromuscular blocking agent or a bolus dose of remifentanil can be administered. We hypothesized that rocuronium 0.6 mg·kg−1 provided a larger proportion of excellent intubating conditions compared to remifentanil 2 µg·kg−1 in patients above 80 years. Methods A total of 78 patients were randomized to either rocuronium 0.6 mg·kg−1 or remifentanil 2 µg·kg−1. General anaesthesia was initiated with fentanyl and propofol. Two minutes after the administration of either rocuronium or remifentanil, tracheal intubating conditions were evaluated using the Fuchs‐Buder scale by a blinded investigator, and our primary outcome was the proportion of patients presenting intubating conditions deemed as excellent. Further outcomes included the Intubating Difficulty Scale (IDS), hoarseness or sore throat 24 h postoperatively, and intervention against hypotension. Results No difference in the occurrence of excellent intubating conditions was found comparing the rocuronium group with the remifentanil group; 10 (28%) versus 15 (39%) (p = .29), respectively, relative risk = 0.72. Interventions against hypotension were used in 24 (67%) versus 28 (74%) (p = .51), respectively. Hoarseness and sore throat 24 h postoperatively were found in 37% versus 35% p = .86, and 14% versus 5% p = .20, respectively. The IDS score was 2 versus 2 p = .48. Conclusion No difference in intubating conditions was found 2 min after the administration of either rocuronium 0.6 mg·kg−1 or remifentanil 2 µg·kg−1 in patients aged above 80 years. Intubation conditions were less than optimal in a large proportion of this patient population. Clinical trials registration NCT04287426.