Combined RSBI, TOF, and BIS for Prediction of Extubation Success

Inclusion Criteria: * Age between 18 and 80 years * ASA physical status I-III * Patients scheduled for elective surgery under general anesthesia * Patients undergoing endotracheal intubation during general anesthesia * Patients receiving neuromuscular blocking agents during anesthesia * Patients planned for extubation in the operating room * Availability of pre-extubation RSBI, TOF ratio, and BIS measurements * Written informed consent obtained from the patient Exclusion Criteria: * Emergency surgery * Age \<18 years or \>80 years * ASA physical status IV or higher * Known or anticipated difficult airway * Anticipated difficult extubation * Preoperative mechanical ventilation * Planned postoperative mechanical ventilation or transfer to the intensive care unit while intubated * Known neuromuscular disease * Severe chronic respiratory failure * Severe chronic obstructive pulmonary disease associated with respiratory failure * Significant neurological disease affecting respiratory drive or level of consciousness * Conditions or medications that may interfere with reliable neuromuscular monitoring * Inability to obtain reliable RSBI, TOF ratio, or BIS measurements * Refusal to participate * Incomplete perioperative or post-extubation outcome data