Frailty is a common and morbid condition found with a higher prevalence in older adults before surgery (25%- 56%) than in community-dwelling elders (10%). Frailty has been conceptualized in two major ways: one includes decreased reserve to physiologic stress and is characterized by decline across organ systems; and the other is an accumulation of deficits, that is, the accumulation of comorbid states that can result in overall physiologic vulnerability. Frailty has been shown to correlate with poor postoperative outcomes (death, complications) in a wide rangeof major surgeries. A frailty screen that includes grip strength may not be best suited for a cervical spine population that often has cervical myelopathy. The preoperative testing facility may dictate the type of assessment possible; some preoperative clinic areas are not suitable for a 5-meter gait speed test.

Residual neuromuscular blockade is one of the most serious clinical problems in postoperative settings. It may also lead to significant increases in respiratory morbidity and health-care utilization while putting patients at additional risk. Even though the availability of new drugs and new protocols should help us prevent residual neuromuscular blockade, its incidence has not yet changed significantly.It is important that clinicians have information regarding variables that predict the duration of action of neuromuscular blocking drugs. The patient’s ability to raise and maintain the head for 5 seconds, show the tongue, open the eyes, or cough, and adequate tidal ventilation are frequently used to predict postoperative muscle relaxant recovery. However, these assessments are often not performed correctly. In addition, the above tests do not solely exclude clinically significant residual curarization after general anesthesia.