The aim of this study was to compare the hemodynamic and recovery profiles of desflurane-remifentanil and desfluranefentanyl in patients undergoing intracranial surgery. Adult patients with American Society of Anesthesiologist (ASA) II to III physical status who were undergoing intracranial surgery for vascular or space-occupying lesions were enrolled in a prospective randomized 2-group study. Anesthesia induction was performed by means of propofol and remifentanil or fentanyl. Anesthesia was maintained with an infusion of remifentanil at a rate of 0.25 mug/kg(-1)/min(-1) plus 1.5% to 2% desflurane/50% N2O/50% O-2 in the group administered desflurane-remifentanil (DR group) or bolus doses of fentanyl (2 mug/kg(-1)) plus 3% to 6% desflurane/50% N2O/50% O-2 in the group administered desflurane-fentanyl (DF group). In both groups, hemodynamic variables were recorded at baseline and after anesthesia induction, tracheal intubation, head holder application, skin and dural incisions, and dural closure. At the end of the surgery, times to extubation, eye opening, following verbal commands, and side effects were recorded. After intubation and skin incision, diastolic arterial pressure, heart rate, and mean arterial pressure values were significantly higher in the DF group. Times to extubation, eye opening, and following verbal commands were significantly shorter in the DR group than in the DF group (P < 0.05). Analgesic consumption and side effects were similar between the 2 groups. Remifentanil at a dose of 0.25 mug/kg(-1)/min(-1) plus 1.5% to 2% desflurane led to rapid emergence from anesthesia, good control of hemodynamic responses, and similar side effects in patients undergoing intracranial surgery compared with giving bolus doses of fentanyl (2 mug/kg(-1)) plus 3% to 6% desflurane.