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
- Rocuronium long activity may otherwise outlast sedation, and result in unsedated paralysis
- 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