Junior SRNA doing my first thymectomy, PRIOR to having my thoracic lectures scheduled later this semester. Just got the case, doing it tomorrow, I have read a fair amount about it but am wondering if I could use N2O? None of the books I have suggest it but it seems like a good agent to me, if I can't use remi (we don't have it) and opioids are risky r/t resp depression. Not knowing anything about the patient or what approach the surgeon will take, my induction plan is to give a touch of midazolam 0.5-1mg, maybe 50mcg fentanyl and go with an inhalation induction using sevoflurane. I'll have propofol if I need it and of course, sux. I would think oxygen/nitrous/sevo +/- background propofol would be a nice way to go, giving 1G IV acetaminophen for post-op pain (plus the nitrous). I would get some analgesia from the N2O and not have to give opioids at the end. This plan is based on the transcervical approach. Everything changes with sternotomy obviously but that almost makes it a bit easier, with the chance of post-op vent being likely. Any help from you guys would be great... is nitrous OK for transcervical thymectomy? Am I missing something? Is my plan acceptable?