 After pre-oxygenation, general anesthesia will be induced with lidocaine 1 mgkg Ideal Body Weight, propofol 1-2 mgkg Actual Body Weight, and fentanyl up to 5 mcgkg Actual Body Weight. Additionally all subjects with receive 2 mg midazolam. Tracheal intubation will be facilitated with rocuronium 0.6 - 1.2 mgkg Actual Body Weight. Anesthesia will be maintained with airoxygen 6040 and desflurane. A remifentanyl infusion 0.05-2mcgkgmin Ideal Body Weight will be continued throughout the entire case with no further analgesics being administered. All patients will receive ondansetron 4 mg prior to the end of operation as well as additional antiemetics in the PACU as judged by the attending anesthesiologist. Patients will be awakened and extubated in the OR meeting standard extubation criteria. Once extubated all patients will then be transferred to the PACU where they will be assessed via the SPEEDs criteria 5 minutes after arrival and then every 15 minutes for the duration of their PACU stay. While in the PACU, all patients will be assessed for pain using the Visual Analog Scale. Pain will be treated as per our protocol with 0.2mg IV hydromorphone for mild pain VAS 1-3, 0.4 mg IV hydromorphone for moderate pain VAS 4-6, and 0.6 mg IV hydromorphone VAS 7-10. As soon as a patient meets all the SPEEDs criteria heshe will be transferred to phase II of the recovery. In phase II, if need be, pain will be managed according to the following orders: 0.2mg intravenous hydromorphone for mild pain VAS 1-3, 0.4 mg intravenous hydromorphone for moderate pain VAS 4-6 and 0.6mg intravenous hydromorphone for severe pain VAS 7-10. 