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You are in Home >> Resources >> Pharmacology >> Neuromuscular blockade and reversal

Rocuronium

Created: 25/7/2006
Updated: 13/2/2007

 
 

Chemical structure


An aminosteroid which is structurally related to vecuronium.



Presentation


As a clear solution containing 10 mg/ml. Available in 5 ml and 10 ml ampoules.

Cardiovascular effects

Minimal; with large doses, a mild vagolytic effect leads to a slight increase in heart rate and mean arterial pressure.

Respiratory effects


No significant histamine release. Bronchospasm is extremely uncommon.

Distribution, metabolism and excretion

Rocuronium is 30% protein bound in the plasma. No metabolites have been detected in plasma or urine. Excreted primarily by hepatic uptake and hepatobiliary excretion. The pharmacokinetics are not significantly altered in renal failure.

Dose, administration and use


Rocuronium is administered intravenously. The normal intubating dose is 0.6 mg/kg, with subsequent doses of one quarter this amount. The drug is non-cumulative with repeated administration. In animal studies, Rocuronium does not appear to be a triggering factor for malignant hyperthermia.

Dosage and duration

Dose (mg/kg) Duration (minutes) Intubation (seconds) 
0.3 - 0.45 13 - 26 120
0.6 30 - 40 60
0.9 53 45

Storage


3 years - between 2-8 degrees C or
3 months - below 30 degrees C

Current discussions re Rocuronium



1. Anaphylaxis and Rocuronium

References

[i] Anaphylactic reactions to neuromuscular blocking drugs
PowerPoint presentation by Professor J. Hunter, University of Liverpool, Editor-in-chief of the British Journal of Anaesthesia. (AnaesthesiaUK would like to thank Professor Hunter for allowing the display of this educational presentation)

[ii] Rocuronium and anaphylaxis - a statistical challenge
Laake JH, Rottingen JA. Department of Anaesthesiology, National Hospital (Rikshospitalet), Oslo, Norway. j.h.laake@basalmed.uio.no
Acta Anaesthesiol Scand 2001; 45(10): 1196-203

[iii] Incidence of UK reactions involving rocuronium may simply reflect market use
Watkins J
Br J Anaesth 2001; 87(3): 522

Download the following references in PDF format.

[v] Danish Anaesthesia Allergy Centre - preliminary results.
Garvey LH, Roed-Petersen J, Menne T, Husum B
Acta Anaesthesiol Scand 2001; 45: 1204-9

[vi] Rocuronium and anaphylaxis - a statistical challenge (see above)
Laake JH, Rottingen JA
Acta Anaesthesiol Scand 2001; 45(10): 1196-203

[vii] Anaphylaxis during anaesthesia
Plaud B, Donati F, Debaene B
Br J Anaesth 2002; 88(4): 604-5

2. Use of Rocuronium in rapid sequence induction for obstetric anaesthesia

Dr D Levy presented the following argument at the Obstetric Anaesthetists' Association Meeting in London 2002 and has published this work in a recent British Journal of Anaesthesia CEPD review. The principal reason for the continuing use of succinylcholine, the rapid recovery of maternal neuromuscular function in the event of an airway crisis, was never originally considered potentially advantageous. The estimated incidence of serious reaction to succinylcholine is 1:4000 inductions. Anaphylaxis to succinylcholine has been responsible for maternal deaths at Caesarean section, and many near misses. Rocuronium 0.6 mg/kg is licensed for Caesarean section and has been shown to produce acceptable intubating conditions after Thiopental 6 mg/kg within 90 seconds. Unlike the case with succinylcholine in failed intubation, optimal conditions for airway management and maintaining oxygenation will be sustained and vomiting cannot occur. Maintenance of a slight head up tilt should allow gravity to reduce the risk of reflux of gastric contents. In the most unlikely event of airway obstruction at the glottis causing a ‘can’t intubate, can’t ventilate’ scenario, the best chance of successful cricothyrotomy will be afforded by profound neuromuscular block.

References

[i] Target controlled infusion of rocuronium: analysis of effect data to select a pharmacokinetic model.

Vermeyen KM
, Hoffmann VL, 
Saldien V
Br J Anaesth 2003; 90(2): 183-8

[ii] Anaesthetic reactions
In: Watkins J, Levy CJ, eds. Guide to Immediate Anaesthetic Reactions. London: Butterworths, 1988; p 27


ArticleDate:20060725
SiteSection: Article
 
   
    
                                            
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