No

Neuromuscular Blocker Agent, Nondepolarizing

Inpatient and outpatient use as an adjunct to general anesthesia to facilitate both rapid-sequence and routine tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation

B

Known hypersensitivity to rocuronium or vecuronium

Use with caution in patients with cardiovascular or pulmonary disease, hepatic impairment, neuromuscular disease, myasthenia gravis, dehydration (may alter neuromuscular blocking effects); respiratory acidosis, hypomagnesemia, hypokalemia, or hypocalcemia (may enhance actions) and the elderly; ventilation must be supported during neuromuscular blockade

>1%: Cardiovascular: Transient hypotension and hypertension

<1%: Arrhythmias, abnormal EKG, tachycardia, edema, rash, injection site pruritus, nausea, vomiting, bronchospasm, wheezing, rhonchi, hiccups

Symptoms of overdose include prolonged skeletal muscle block, muscle weakness and apnea

Treatment is maintenance of a patent airway and controlled ventilation until recovery of normal neuromuscular block is observed, further recovery may be facilitated by administering an anticholinesterase agent (eg, neostigmine, edrophonium, or pyridostigmine) with atropine, to antagonize the skeletal muscle relaxation; support of the cardiovascular system with fluids and pressors may be necessary

Decreased effect: Chronic carbamazepine or phenytoin can shorten the duration of neuromuscular blockade; phenylephrine can severely inhibit neuromuscular blockade

Increased effect: Infusion requirements are reduced 35% to 40% during anesthesia with enflurane or isoflurane

Increased toxicity: Aminoglycosides, vancomycin, tetracyclines, bacitracin

Store under refrigeration (2°C to 8°C), do not freeze; when stored at room temperature, it is stable for 30 days; unlike vecuronium, it is stable in 0.9% sodium chloride and 5% dextrose in water, this mixture should be used within 24 hours of preparation

Blocks acetylcholine from binding to receptors on motor endplate inhibiting depolarization

Onset: Good intubation conditions within 1-2 minutes; maximum neuromuscular blockade within 4 minutes

Duration: ~30 minutes (with standard doses, increases with higher doses)

Metabolism: Undergoes minimal hepatic metabolism

Elimination: Primarily through hepatic uptake and biliary excretion

Children:

Initial: 0.6 mg/kg under halothane anesthesia produce excellent to good intubating conditions within 1 minute and will provide a median time of 41 minutes of clinical relaxation in children 3 months to 1 year of age, and 27 minutes in children 1-12 years

Maintenance: 0.075-0.125 mg/kg administered upon return of T₁ to 25% of control provides clinical relaxation for 7-10 minutes

Adults:

Tracheal intubation: I.V.:

Initial: 0.6 mg/kg is expected to provide approximately 31 minutes of clinical relaxation under opioid/nitrous oxide/oxygen anesthesia with neuromuscular block sufficient for intubation attained in 1-2 minutes; lower doses (0.45 mg/kg) may be used to provide 22 minutes of clinical relaxation with median time to neuromuscular block of 1-3 minutes; maximum blockade is achieved in <4 minutes

Maximum: 0.9-1.2 mg/kg may be given during surgery under opioid/nitrous oxide/oxygen anesthesia without adverse cardiovascular effects and is expected to provide 58-67 minutes of clinical relaxation; neuromuscular blockade sufficient for intubation is achieved in <2 minutes with maximum blockade in <3 minutes

Maintenance: 0.1, 0.15, and 0.2 mg/kg administered at 25% recovery of control T₁ (defined as 3 twitches of train-of-four) provides a median of 12, 17, and 24 minutes of clinical duration under anesthesia

Rapid sequence intubation: 0.6-1.2 mg/kg in appropriately premedicated and anesthetized patients with excellent or good intubating conditions within 2 minutes

Continuous infusion: Initial: 0.01-0.012 mg/kg/minute only after early evidence of spontaneous recovery of neuromuscular function is evident

Dosing adjustment in hepatic impairment: Reductions are necessary in patients with liver disease

Administer I.V. only

Peripheral nerve stimulator measuring twitch response, heart rate, blood pressure, assisted ventilation status

Concurrent sedation and analgesia are needed

Injection, as bromide: 10 mg/mL (5 mL, 10 mL)

Bartkowski RR, Witkowski TA, Azad S, et al, "Rocuronium Onset of Action: A Comparison With Atracurium and Vecuronium," Anesth Analg, 1993, 77(3):574-8.

Khuenl-Brady KS, Sparr H, Puhringer F, et al, "Rocuronium Bromide in the ICU: Dose Finding and Pharmacokinetics," Eur J Anaesthesiol Suppl, 1995, 11:79-80.

Puhringer FK, Khuenl-Brady KS, and Mitterschiffthaler G, "Rocuronium Bromide: Time-Course of Action in Underweight, Normal Weight, Overweight and Obese Patients," Eur J Anaesthesiol Suppl, 1995, 11:107-10.