a non-depolarising competitive acetylcholine antagonist at nicotinic receptors
a commonly used non-depolarising neuromuscular blocking agent (NMBA) in the ED for induction when suxamethonium contra-indicated.
as with other non-depolarising NMBAs, its actions can be reversed with neostigmine (0.06 to 0.08 mg/kg IV) after approximately 40 percent of neuromuscular function has returned
usage as an induction NMBA
vecuronium or rocuronium can be used at induction if suxamethonium is contra-indicated or not desired.
rocuronium has a shorter time to onset and shorter duration of action compared to other agents in its class.
unlike suxamethonium, instead of waiting for fasciculations to subside, just wait 45 secs then proceed
multiple studies and systematic reviews demonstrate it creates intubating conditions comparable to suxamethonium.
duration of action after 1mg/kg dose is ~1hr and may be > 90min after 1-2-1.6mg/kg dose
in the event of can't intubate, can't ventilate scenario, it's effects can be reversed by sugammadex
routine elective intubations
dose for routine elective intubations is 0.6mg/kg with conditions suitable for intubation by 60sec
The clinical duration (the duration until spontaneous recovery to 25% of control twitch height) with rocuronium bromide 0.6 mg/kg is 30 to 40 minutes.
The total duration (time until spontaneous recovery to 90% of control twitch height) is 50 minutes.
The mean time of spontaneous recovery of twitch response from 25 to 75% (recovery index) after a bolus dose of rocuronium bromide 0.6 mg/kg is 14 minutes.
maintenance dose
obese patients (> 30% over ideal weight): calculate dose using lean body mass.
usual maintenance dose 0.15 mg/kg bolus as needed (usually every 10-15min)
duration of action ~13min (up to 20min in those with liver disease or with inhalational anaesthesia)