Clinical Research Directory

Inclusion Criteria: * American Society of Anesthesiologists (ASA) physical status I-III * Scheduled for elective spine surgery (cervical, thoracic, or lumbar) requiring intraoperative MEP monitoring * Able to provide written informed consent Exclusion Criteria: * Known or suspected difficult airway (Mallampati class IV, history of difficult intubation, limited mouth opening \< 3 cm, limited neck extension) * Body mass index (BMI) \> 40 kg/m2 * Known allergy or hypersensitivity to remifentanil, succinylcholine, rocuronium, sugammadex, or propofol * Personal or family history of malignant hyperthermia * Known or suspected pseudocholinesterase deficiency * Conditions predisposing to succinylcholine-induced hyperkalemia (e.g., major burns within the last year, denervation injuries or upper motor neuron lesions within 6 months, severe crush injuries, prolonged immobilization \> 72 hours, known hyperkalemia \> 5.5 mEq/L) * Severe preoperative motor deficit (manual muscle testing ≤ 2/5 in monitored extremities) * Neuromuscular disorders (e.g., myasthenia gravis, muscular dystrophy, Guillain-Barre syndrome, prior stroke with residual motor deficits) * Severe cardiovascular disease (e.g., ejection fraction \< 30%, unstable angina, myocardial infarction within 3 months) * Severe bradycardia (heart rate \< 50 bpm) or high-grade atrioventricular block without a pacemaker * Current use of medications affecting neuromuscular function (aminoglycosides, magnesium infusion, certain antiepileptic meds, etc.) * Emergency surgery * High aspiration risk (e.g., uncontrolled gastroesophageal reflux disease) * Pregnancy or breastfeeding