Rocuronium

What is Rocuronium? 1

  • An intermediate-acting non-depolarizing neuromuscular blocking drug (NDMR) used for rapid induction and intubation.
  • Popular for short and intermediate procedures due to its rapid onset and ability to induce neuromuscular block quickly.

Mechanism of Action & Pharmacokinetics 12

  • Rocuronium competitively binds to nicotinic acetylcholine receptors at the neuromuscular junction. This prevents ACh from causing muscle contraction
  • Onset time is 60-80 seconds for an intubating dose (approximately 0.6 mg/kg).
  • Duration of action: 35-45 minutes.
  • Dosage is typically based on ideal body weight (IBW) for intubation. 2

Pharmacodynamics 1

Cardiovascular

  • Few cardiovascular effects.

    Respiratory

  • Paralysis impairs airway protection and respiration. Reversal of paralysis must be achieved prior to airway removal.

    Neurological

  • Adequate depth of anesthesia must be maintained to minimize the risk of awareness during paralysis.

Indications 1

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    and intubation (opens vocal cords, improves laryngoscopy view).
  • Maintenance of neuromuscular block during surgery.
  • Alternative to succinylcholine in situations where a rapid onset is required without the associated side effects of depolarizing agents.

Dosage 1

  • Intubation Dose: 0.6 mg/kg based on ideal body weight (IBW), 1.2 mg/kg for rapid sequence intubation based on ideal body weight (IBW).
  • Maintenance Infusion: Dose adjusted based on lean body weight (LBW) to avoid prolonged neuromuscular block, particularly in obese patients. 2

Contraindications 1

  • Hypersensitivity to rocuronium or any component of the formulation.
  • Use with caution in patients with known neuromuscular disorders.

Complications 1

  • Prolonged neuromuscular block, especially in patients with renal impairment.
  • Anaphylaxis, though rare, has been reported.

References

  1. Birdi T, Sullivan P. Ottawa Anesthesia Primer. Toronto, Ontario: Echo Book Publishing; 2012.  2 3 4 5 6 7

  2. De Baerdemaeker LE, Mortier EP, Struys MM. Pharmacokinetics in obese patients. Continuing Education in Anaesthesia Critical Care & Pain. 2004 Oct;4(5):152–5.  2 3