This randomized controlled double-blind trial was designed to compare the presence of Airway-Circulatory Reflexes to tracheal extubation in groups administering IV alfentanil or lidocaine, in 150 patients undergoing cesarean surgery receiving a standardized anesthetic protocol. At the end of surgery, after return of spontaneous ventilation, patients received either alfentanil 15 μg kg-1 or lidocaine 1.5 mg kg-1. The presence of cough and it`s severity during emergence before extubation was noted. BP and HR were recorded at 2 min after end of surgery (baseline), 2 min after study drug administration and 1 min after extubation. The groups were matched according to age, baseline BP and HR. The incidence of coughing was less frequent in the alfentanil than in the lidocaine group (19% versus 75%, respectively, p<0.001). Although the severity of coughing was considerably different between two groups (lower in alfentanil g) but was not statistically different (p = 0.292). The mean BP and HR were lower in alfentanil than lidocaine group 2 min after administration and 1 min after extubation (p<0.001). The median of delay time (time between the study drug administration and extubation) was 6 min in alfentanil (Range: 4-8) and 5 min in lidocaine groups (Range: 4-8) (p<0.001). These results indicate that alfentanil decreases Airway-Circulatory Reflexes more than lidocaine during emergence from anesthesia without clinically important prolonging the time to extubation.