Inclusion Criteria:  Patients undergoing tonsillectomy or adenotonsillectomy Ages 2 to up to 8 years Preoperative sleep study demonstrating obstructive sleep apnea Intubation without medication (e.g. no propofol prior to intubation) Requirement for airway instrumentation: LMA or ETT Inhalation induction of anesthesia  Exclusion Criteria:  No obstructive sleep apnea Central sleep apnea events >5/hour IV induction of anesthesia Syndromic patients Known or suspected difficult airway Allergy to Fentanyl Known cardiovascular medications Pulmonary hypertension Total intravenous anesthesia required Parental refusal