Study of Recovery of Strength After Surgery Comparing Two Different Medications for Reversal of Muscle Relaxant

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