Pharm

Rocuronium

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Rocuronium, Rocuronium Bromide, Esmeron, Zemuron

  • Mechanism
  1. Non-depolarizing Neuromuscular Blocking Agent (Acetylcholine antagonists)
  • Indications
  1. Paralysis in Rapid Sequence Intubation
  2. Paralytic Agent of choice in children (and in adults if Succinylcholine contraindicated)
  • Preparations
  1. Rocuronium 10 mg/ml in 100 mg/10 ml vial
  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]
  • Pharmacokinetics
  1. Duration of paralysis: 45 minutes
  2. Critical to initiate longer acting sedation immediately following intubation
    1. Rocuronium long activity may otherwise outlast sedation, and result in unsedated paralysis
  • 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]
  • Management
  • Reversal
  1. Sugammadex tightly binds Rocuronium and Vecuronium to reverse paralysis (FDA approved in U.S. in 2016)
  • References
  1. Strayer in Herbert (2016) EM:Rap 16(8):3-4