Rocuronium

Aka: Rocuronium, Rocuronium Bromide, Esmeron, Zemuron

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II. Mechanism

  1. Non-depolarizing Neuromuscular Blocking Agent (AcetylcholineAntagonists)

III. Indications

  1. Paralysis in Rapid Sequence Intubation
  2. Paralytic Agent of choice in children (and in adults if Succinylcholine contraindicated)

IV. Preparations

  1. Rocuronium 10 mg/ml in 100 mg/10 ml vial

V. Dosing: Paralysis in Rapid Sequence Intubation

  1. Rocuronium 1.2 mg/kg (96 mg for 80 kg adult)
    1. Prior recommended doses of 0.6 to 0.1 mg/kg had delayed onset compared with Succinylcholine
    2. Rocuronium 1.2 mg/kg is equivalent to Succinylcholine full activity onset
    3. Tran (2015) Cochrane Database Syst Rev 10:CD002788 +PMID:26512948 [PubMed]

VI. Pharmacokinetics

  1. Onset: 1 to 3 minutes
  2. Duration of paralysis: 45 minutes
  3. Critical to initiate longer acting sedation immediately following intubation
    1. Rocuronium long activity may otherwise outlast sedation, and result in unsedated paralysis
    2. Consider large Ketamine dose (e.g. 200 mg IV in adults) at RSI while initiating sedation (e.g. Propofol infusion)
  4. Hepatic Clearance

VII. Precautions

  1. Inadequate sedation and analgesia is common following Rocuronium
    1. Err on the side of more aggressive sedation and analgesia while patient paralyzed
    2. Korinek (2014) Eur J Emerg Med 21(3): 206-11 +PMID:23510899 [PubMed]

VIII. Management: Reversal

  1. Sugammadex tightly binds Rocuronium and Vecuronium to reverse paralysis (FDA approved in U.S. in 2016)

IX. References

  1. Strayer in Herbert (2016) EM:Rap 16(8):3-4

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