II. Mechanism
III. Indications
- Paralysis in Rapid Sequence Intubation
- Paralytic Agent of choice in children (and in adults if Succinylcholine contraindicated)
IV. Preparations
- Rocuronium 10 mg/ml in 100 mg/10 ml vial
V. Dosing: Paralysis in Rapid Sequence Intubation
- Rocuronium 1.2 mg/kg (96 mg for 80 kg adult)
- Prior recommended doses of 0.6 to 0.1 mg/kg had delayed onset compared with Succinylcholine
- Rocuronium 1.2 mg/kg is equivalent to Succinylcholine full activity onset
- Tran (2015) Cochrane Database Syst Rev 10:CD002788 +PMID:26512948 [PubMed]
VI. Pharmacokinetics
- Onset: 1 to 3 minutes
- Duration of paralysis: 45 minutes
- Critical to initiate longer acting sedation immediately following intubation
- Hepatic Clearance
VII. Precautions
- Inadequate sedation and analgesia is common following Rocuronium
- Err on the side of more aggressive sedation and analgesia while patient paralyzed
- Korinek (2014) Eur J Emerg Med 21(3): 206-11 +PMID:23510899 [PubMed]
VIII. Management: Reversal
- Sugammadex tightly binds Rocuronium and Vecuronium to reverse paralysis (FDA approved in U.S. in 2016)
IX. References
- Strayer in Herbert (2016) EM:Rap 16(8):3-4
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Related Studies
| Definition (NCI) | The bromide salt form of rocuronium, an intermediate-acting quaternary aminosteroid with muscle relaxant property. Rocuronium bromide competitively binds to the nicotinic receptor at the motor end plate, and antagonizes acetylcholine binding, which results in skeletal muscle relaxation and paralysis. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C061870 |
| SnomedCT | 334060005, 108450002 |
| English | Pyrrolidinium, 1-((2beta,3alpha,5alpha,16beta,17beta)-17-(acetyloxy)-3-hydroxy-2-(4-morpholinyl)androstan-16-yl)-1-(2-propenyl)-, Bromide, muscle relaxants skeletal rocuronium bromide, rocuronium bromide (medication), ROCURONIUM BROMIDE, rocuronium bromide, Rocuronium bromide, Rocuronium bromide (substance), Rocuronium bromide [dup] (substance), pyrrolidinium, 1-((2beta,3alpha,5alpha,16beta,17beta)-17-(acetyloxy)-3-hydroxy-2-(4-morpholinyl)androstan-16-yl)-1-(2-propenyl)-, bromide, Rocuronium Bromide |
| Spanish | bromuro de rocuronio (sustancia), bromuro de rocuronio |
Ontology: Rocuronium (C0209337)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C061870 |
| SnomedCT | 108449002, 372494005 |
| LNC | LP62278-4 |
| English | 1-(17-(acetoyl)-3-hydroxy-2-(4-morpholinyl)androstan-16-yl)-1-(2-propenyl)pyrrolidinium, ROCURONIUM, Rocuronium, Rocuronium (product), Rocuronium (substance), rocuronium |
| Spanish | rocuronio (producto), rocuronio (sustancia), rocuronio, roncuronio (sustancia), roncuronio |
Ontology: Zemuron (C0591463)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C061870 |
| English | zemuron, Zemuron, Organon Teknika brand of rocuronium bromide, Organon brand of rocuronium bromide |
Ontology: Esmeron (C2825405)
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| MSH | C061870 |
| English | Esmeron, Esmerone |
