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However, the effects of hypoxia on perioperative narcotic requirements in otherwise healthy children have not been previously reported. Methods/materials:? We reviewed retrospectively the opioid requirements of pediatric patients who underwent cleft lip or palate surgery during Smile Network International mission trips to Cusco and Lima, Peru between 2007 and 2009. Patients who had surgery at high altitude were compared to those who had surgery at sea level. All patients received a standardized anesthetic with intravenous fentanyl as the only perioperative opioid. Results:? Hundred and two patients ABT-263 cell line had surgery at 3399?m above sea level (masl) (Cusco) and 169 patients had surgery at 150?masl (Lima). Patients at high altitude had significantly lower baseline oxygen saturations (92?��?4% vs 98?��?3%; P?Flavoprotein P?Rapamycin in vivo cardiopulmonary bypass (CPB) pump may result in excess protamine and contributes toward a coagulopathy that can be detected by ACT and TEG in pediatric patients. A total of 100 pediatric patients 1?month to ��5?years of age undergoing CPB were included in this retrospective before/after design study. Combined-EBV group consisted of 50 consecutive patients whose protamine dose was calculated to neutralize heparin in the combined EBVs of the patient and the pump. Pt-EBV group consisted of the next 50 consecutive patients whose protamine dose was calculated to neutralize heparin in the patient's EBV. Baseline and postprotamine ACTs were similar between groups. Postprotamine heparin assay (Hepcon) showed the absence of residual heparin in both groups. Postprotamine kaolin-heparinase TEG showed that R was prolonged by 7.5?min in the Combined-EBV group compared with the Pt-EBV group (mean R of 20.17 vs 12.4�min, respectively, P??.001). Increasing doses of protamine were associated with a corresponding, but nonlinear increase in R. There was no significant difference in the changes for K, alpha, and MA between the groups.