OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• neuro-muscular blockers
• rapid sequence induction (RSI) for emergency intubation

• 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

• 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.

• dose: 1.2-1.6mg/kg lean body mass iv
• its time to intubation-level paralysis is approximately 45 seconds, when the recommended dose for rapid sequence induction (RSI) for emergency intubation of 1.2-1.6 mg/kg IV is given
  • 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

• 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.

• 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)

• Prior anaphylactic reactions; neuromuscular, CV, hepatobiliary disease; poliomyelitis; acid/ base, electrolyte imbalance; dehydration; hypothermia; obesity; oedema; renal failure; prolonged use (> 48 hrs); burns; multiple organ failure; monitor neuromuscular transmission; ensure adequate analgesia, sedation; elderly, debility; pregnancy, lactation, infants (1-12 mths)