This study aims to determine the optimal dose of alfentanil in suppressing the airway reflexes during supreme LMA removal in anaesthetized adult.

The removal of LMA may be associated with coughing, biting, agitation and airway complication such as laryngospasm. Thus it is advisable to remove the LMA when the patient is breathing spontaneously and when the airway reflexes are still depressed. A number of techniques have been used to prevent this adverse emergence phenomenon, such as removing the tube while the patient is in deep plane of anaesthesia or administration of local anaesthetic and intravenous opioids

The administration of intravenous opioids before emergence may be useful for preventing cough, agitation and hemodynamic response. Alfentanyl is proven to suppress cough and agitation during the endotracheal tube emergence. However, its use in suppressing cough in LMA patient has not been evaluated.

Inclusion Criteria:

1. ASA I and II patients
2. Age 18 to 49 years old
3. Minor elective day care surgery (> 20 minute and less than 2 hours) which require local anaesthetic infiltration and does not require use of long acting opioids.

Exclusion Criteria:

1. Potential difficult airway
2. Reactive airway disease or sign and symptoms of upper respiratory tract infection.
3. History of cardiac, pulmonary and renal diseases
4. Body Mass Index > 30 kgm2.
5. Risk of aspiration.
6. Poor dentition with high risk of damage.
7. Patient refusal.