Inclusion Criteria:  patient age 18-85 ASA (American Society of Anesthesiologists) Physical Status Classification 1-3 Glasgow Coma Scale (GCS) of 15 Adequate english comprehension  Exclusion Criteria:  pregnant or nursing patients patients with known allergies to any of the study drugs patient's refusal patients with a history of cirrhosis chronic kidney disease stage 3 or higher known history of substance abuse history of neuromuscular disease history of heart block