The aim of this study is to compare the effect of Alfentanil, Lidocaine and combination of Alfentanil plus Lidocaine to control hemodynamic responses during awake extubation.Inclusion criteria are upper limb orthopedic surgery and age between 20 - 40 years old. Exclusion criteria are smoking, addiction, cardiac respiratory disease, age less than 20, age more than 40 and drug allergy. 172 patients , divide into four equal groups. Group A; receives Alfentanil 5 microgram per kilogram, group B; receives Lidocaine 1 milligram per kilogram, group C; receives Alfentanil plus Lidocaine, and group D; receives normal saline. The mean systolic blood pressure, mean diastolic blood pressure, mean arterial pressure and heart rate measure and record before extubation and during extubation. Also, it measures and records 1, 5, 10, 15, and 20 minutes after extubation, bucking statue after extubation is recorded.