Inclusion Criteria:

- ASA 1-2 patients

- Age 18-65 years

- body mass index (BMI) ≤ 35kg/m2

- Planned surgery requiring general anesthesia lasting approximately 1.5-3.0 hours

- Surgery requires or benefits from skeletal muscle relaxation

- All must pass the baseline 20 mL water swallowing test as previously described.

Exclusion Criteria:

- Pre-existing neuromuscular or central nervous system disorder

- Known condition interfering with gastric emptying

- Planned surgical procedure on the head or neck

- Known liver disease

- Serum creatinine > 1.5 mg/dL

- Concurrent use of neuroleptic medications

- Contraindication or previous adverse response to any of the study drugs

- Active asthma or reactive airways disease

- Surgery where upright position or brief cough would be contraindicated

- Inability to provide informed consent