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Rocuronium
Aka: Rocuronium, Rocuronium Bromide, Esmeron, Zemuron
- See Also
- Paralytic Agent
- Rapid Sequence Intubation (RSI)
- Mechanism
- Non-depolarizing Neuromuscular Blocking Agent (Acetylcholine antagonists)
- Indications
- Paralysis in Rapid Sequence Intubation
- Paralytic Agent of choice in children (and in adults if Succinylcholine contraindicated)
- Preparations
- Rocuronium 10 mg/ml in 100 mg/10 ml vial
- 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]
- Pharmacokinetics
- 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
- 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]
- Management: Reversal
- Sugammadex tightly binds Rocuronium and Vecuronium to reverse paralysis (FDA approved in U.S. in 2016)
- References
- Strayer in Herbert (2016) EM:Rap 16(8):3-4