The purpose of this study is to compare two different medications (neostigmine/glycopyrrolate and sugammadex) to see if one drug improves patient comfort regarding the return of muscle strength after surgery.

Inclusion Criteria:

• Adult patients age 18 years of age or greater who are capable of giving consent
• Undergoing surgical procedures of expected length 6 </= hours requiring NMB

Exclusion Criteria:

• Pregnancy

• History of documented anaphylaxis or contraindication to any of the study medications

• Active coronary disease with a positive cardiac stress test

• History of severe chronic obstructive pulmonary disease (COPD) defined as an FEV1 < 50% of predicted

• Serum Creatinine >/= 2.0 mg/dL

• Severe hepatic dysfunction accompanied by coagulopathy

  • Definition:
  • Known liver Disease AND
  • INR > 1.5 (except for patients on anticoagulants) AND
  • Platelet count <100,00/ul without other obvious cause

• Chronic sustained release opioid for > 2 weeks duration pre op (in the 30 days prior to surgery)

• Use of toremifene

• Significant cognitive impairment or documented psychologic impairment

• Myasthenia gravis or other neuromuscular disease

• Patients who are not eligible for standard anesthetic induction, eg, those needing rapid sequence induction or awake fiberoptic bronchial intubation.

• American Society of Anesthesiologists (ASA) Status > 3