Rocuronium Bromide

Indications

Rocuronium Bromide is used for: Endotracheal intubation, Aid controlled ventilation, Muscle relaxant in general anesthesia

Adult Dose

Intravenous Muscle relaxant in general anaesthesia; Facilitate endotracheal intubation; Facilitate mechanical ventilation in intensive care Adult: Initially, 600 mcg/kg by inj. Higher doses of 1 mg/kg may be used for intubation during rapid sequence induction of anaesth. Maintenance: 150 mcg/kg by inj (may reduce to 75-100 mcg/kg for prolonged inhalational anaesth) or by infusion at 300-600 mcg/kg/hr. Elderly: Maintenance: 75-100 mcg/kg. Hepatic impairment: Maintenance: 75-100 mcg/kg by inj or 300-400 mcg/kg/hr by infusion.

Child Dose

Intravenous Muscle relaxant in general anaesthesia; Facilitate endotracheal intubation; Facilitate mechanical ventilation in intensive care Child: Initially, 600 mcg/kg by inj. Higher doses of 1 mg/kg may be used for intubation during rapid sequence induction of anaesth. Maintenance: 150 mcg/kg by inj (may reduce to 75-100 mcg/kg for prolonged inhalational anaesth) or by infusion at 300-600 mcg/kg/hr.

Renal Dose

Renal impairment: Maintenance: 75-100 mcg/kg by inj or 300-400 mcg/kg/hr by infusion.

Administration

IV Preparation Dilute with D5W or LR to a final concentration of 0.5 or 1 mg/mL for infusion IV Administration Administer IV only May be given undiluted as a rapid injection or via continuous infusion using an infusion pump

Contra Indications

Hypersensitivity.

Precautions

Patient w/ biliary tract disease, neuromuscular disease, previous poliomyelitis, burn injury, severe electrolyte disturbances, Eaton-Lambert syndrome, myasthenia gravis, CV disease, resp disease, pulmonary HTN; obese patients. Renal and hepatic impairment. Elderly. Pregnancy and lactation. Monitoring Parameters Monitor heart rate, BP, twitch response, assisted ventilation status. Lactation: not known if excreted in breast milk; effect on nursing infant not known

Pregnancy-Lactation

Pregnancy Category: C Lactation: not known if excreted in breast milk; effect on nursing infant not known

Interactions

May cause enhanced block when used with lidocaine, procainamide, quinidine, verapamil, aminoglycosides, inhalational anaesthetics and vancomycin. May cause prolonged paralysis when used with clindamycin. Anticholinesterases such as pyridostigmine and galantamine may antagonise the effect of rocuronium. Chronic use of carbamazepine or phenytoin may lead to resistance to rocuronium.

Adverse Effects

Side effects of Rocuronium Bromide : 1-10% Transient hypotension (1-2%), Hypertension (1-2%) <1% Dose-related tachycardia, Apnea, Abnormal ECG, Injection site edema, Hiccups, Pruritus, Nausea, Wheezing, Residual muscle weakness, Allergic or idiosyncratic hypersensitivity reactions Potentially Fatal: Abnormal ECG, arrhythmia, bronchospasm, anaphylaxis and malignant hyperthermia.

Mechanism of Action

Rocuronium is a competitive neuromuscular blocker that acts by blocking the binding of acetylcholine to receptors on the motor endplate, inhibiting depolarisation.