Rocuronium

See critical care quick reference for drug doses by weight.

General

  • Type: Neuromuscular blocker, Non-Depolarizing, Fast Onset, Intermediate Lasting
  • Dosage Forms: IV
  • Common Trade Names: Zemuron

Adult Dosing

RSI

  • 0.6 to 1.2mg/kg IV (ideal body weight)
  • Onset of action faster with higher dose
  • One study suggests 2.0mg/kg may lead to optimal intubating conditions; however higher doses lead to longer duration of paralysis[1]

Maintenance Bolus Dosing

  • 0.1 to 0.2mg/kg IV

Infusion

  • 10 to 12 mcg/kg/min

Pediatric Dosing

See critical care quick reference for drug doses by weight.

RSI

  • 0.6 to 1.2mg/kg IV (ideal body weight)

Maintenance Bolus Dosing

  • 0.1 to 0.2mg/kg IV

Infusion

  • 10 to 12 mcg/kg/min

Special Populations

  • Pregnancy Rating: C
  • Lactation: Infant risk cannot be ruled out
  • Renal Dosing (half life approximately 1 hour longer if renal transplant patient)
    • Adult
    • Pediatric
  • Hepatic Dosing (half life approximately 3 hours longer with liver dysfunction)
    • Adult
    • Pediatric

Contraindications

  • Allergy to class/drug
  • Do not use without concurrent sedation

Adverse Reactions

Serious

Common

  • Cardiovascular: hypertension (0.1% to 2%)
  • Hypotension (0.1% to 2%)
  • Tachycardia (1% to 5.3%)
  • Dermatologic: Pain at injection site
  • Respiratory: Increased pulmonary vascular resistance (24%)

Pharmacology

  • Half-life: Variable by age, but anywhere from 30 minutes to 2 hours.
  • Metabolism: Metabolite is 17-desacetyl-rocuronium
  • Excretion: Primary route is fecal. Renal also.
  • Mechanism of Action: Non-depolarizing neuromuscular blocking agent. Intermediate duration with dose dependant rapid to intermediate onset. Competes for cholinergic receptors at the motor end-plate. Acetylcholinesterase inhibitors like those found in organophosphates antagonize this action

See Also

Airway Pages

References

  1. Heier T, Caldwell JE. Rapid tracheal intubation with large-dose rocuronium: a probability-based approach. Anesth Analg. 2000 Jan;90(1):175-9. doi: 10.1097/00000539-200001000-00036. PMID: 10625000.