In most clinical instances, direct laryngoscopy and endotracheal intubation is performed after a set time (generally 60 seconds) following the administration of a neuromuscular (NM) blocking agent, rocuronium. Although the average onset time is 60 seconds, clinical studies show a standard deviation around the mean onset time of 10-20 seconds, meaning that a significant number of patients do not achieve complete NM blockade by 60 seconds. Given the above noted variability, complete NM blockade may not be achieved in 60 seconds in a significant percentage of patients, resulting in more problematic direct laryngoscopy and endotracheal intubation. Various studies have shown a higher incidence of perioperative respiratory events and postoperative concerns (sore throat, vocal cord injury) when NM blockade is not complete prior to endotracheal intubation.

This study aims to use the TetraGraph monitor to clearly identify onset times of rocuronium. Additionally, whenever feasible based on the clinical needs of the case, recovery times after the single dose of rocuronium will be recorded.

Inclusion Criteria:

• consenting American Society of Anesthesiologists (ASA) Physical Status 1-4 patients
• undergoing a surgical procedure with general anesthesia and requiring the administration of rocuronium

Exclusion Criteria:

• Patients with history of a progressive or degenerative peripheral neurologic or neuropathic disorder
• Patients undergoing a surgical procedure in which neuromuscular blockade is not required
• Edematous patients