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females. Melatonin Endogenous melatonin is a naturally occurring hormone synthesized and released by the pineal gland. Melatonin is a major regulator of the sleep-wake cycle and circadian rhythms. A natural release of melatonin occurs during periods of environmental darkness and is suppressed by light with peak hours of release between the usual sleep period of 2 and 4 am . 47 The anesthetic effect of melatonin is mediated through enhanced binding of GABA to its GABA A receptors. 48 Exogenous melatonin administration exerts a mild

Biosciences Inc to compete with Ambien and Lunesta. 57 By early 2006, however, they had failed to win federal regulatory approval in the United States, yet literature citing this drug's efficacy from other countries continues to populate the medical literature. 58 Ramelteon (Rozerem) Ramelteon is the first drug in the melatonin receptor agonist class of hypnotic therapies which has recently been FDA-approved for insomnia management and which works by a completely different mechanism than all the medications discussed thus far. 59 The

), marshmallow liquid (qhs), juniper tar oil (qhs), hemp oil (qhs), and melatonin (3 mg, qhs). Because of his large size and combative behavior, his mother was instructed to give his normal morning medications with a sip of water 2 hours prior to his scheduled appointment time. The patient had no reported known drug allergies. Upon presentation, a preoperative assessment revealed no new findings, and the patient was appropriately NPO, having taken his medications as instructed. The patient was transported into the operatory, and standard American Society of

contraindicated. CASE REPORT A wheelchair-bound 31-year-old, 5′1″, 65-kg Caucasian woman presented to the University of Pittsburgh School of Dental Medicine's Center for Patients with Special Needs for restorative dental procedures under general anesthesia. The patient's medical history included cerebral palsy with spastic quadriplegia, scoliosis, intellectual disability, seizure disorder, and severe gastroesophageal reflux disease. Current medications included clobazam, clonazepam, diazepam, docusate, lamotrigine, levocarnitine, lorazepam, melatonin