【Abstract】 Objective To investigate the effects of dextromethorphan combined with remifentanil on the circulation and respiration of bronchoscopic intubation in patients with burned difficult airways and the effects on adverse reactions. Methods A retrospective analysis of 68 patients with burned difficult airways admitted to our hospital between June 2015 and June 2017 was performed. The patients were divided into two groups according to different medications. The observation group received 10 ug/kg dexmedimethamine + 05ug/kg remifentanil, and the control group received tetracaine 3 mL. The sedative effects of heart rate, mean arterial pressure, and respiratory rate in two groups at different times and adverse reaction condition were observed. Results The heart rates of the two groups were significantly slowed after administration. The heart rates of the observation group at T2, T3, and T5 were significantly lower than those of the control group (P＜005). The mean arterial pressure was significantly reduced in the two groups after administration. The mean arterial pressure in the observation group was significantly higher than that in the control group at T2 to T5 (P＜005). Respiratory frequency was significantly reduced in the two groups after administration, and the fluctuation range of respiratory rate was very small in the observation group at different time points. The respiratory rate in the observation group was significantly higher than that in the control group at T2 to T5 (P＜005). The sedation, vocal cord activity, and cough scores in the observation group were lower than those in the control group (P＜005). ⑤ The overall incidence of adverse events in the observation group was significantly lower than that in the control group (4117% vs 7059%) (P＜005). Conclusion The use of dextromethorphan combined with remifentanil anesthetic for bronchoscopic intubation in patients with burned difficult airways has good sedative effect. It can maintain stable hemodynamics, and has good safety.