II. Mechanism

  1. Non-depolarizing Neuromuscular Blocking Agent (Acetylcholine antagonists)

III. Indications

  1. Paralysis in Rapid Sequence Intubation
  2. Paralytic Agent of choice in children (and in adults if Succinylcholine contraindicated)

IV. Preparations

  1. Rocuronium 10 mg/ml in 100 mg/10 ml vial

V. Dosing: Paralysis in Rapid Sequence Intubation

  1. Rocuronium 1.2 mg/kg (96 mg for 80 kg adult)
    1. Prior recommended doses of 0.6 to 0.1 mg/kg had delayed onset compared with Succinylcholine
    2. Rocuronium 1.2 mg/kg is equivalent to Succinylcholine full activity onset
    3. Tran (2015) Cochrane Database Syst Rev 10:CD002788 +PMID:26512948 [PubMed]

VI. Pharmacokinetics

  1. Duration of paralysis: 45 minutes
  2. Critical to initiate longer acting Sedation immediately following intubation
    1. Rocuronium long activity may otherwise outlast Sedation, and result in unsedated paralysis

VII. Precautions

  1. Inadequate Sedation and analgesia is common following Rocuronium
    1. Err on the side of more aggressive Sedation and analgesia while patient paralyzed
    2. Korinek (2014) Eur J Emerg Med 21(3): 206-11 +PMID:23510899 [PubMed]

VIII. Management: Reversal

  1. Sugammadex tightly binds Rocuronium and Vecuronium to reverse paralysis (FDA approved in U.S. in 2016)

IX. References

  1. Strayer in Herbert (2016) EM:Rap 16(8):3-4

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Ontology: rocuronium bromide (C0069632)

Definition (NCI) The bromide salt form of rocuronium, an intermediate-acting quaternary aminosteroid with muscle relaxant property. Rocuronium bromide competitively binds to the nicotinic receptor at the motor end plate, and antagonizes acetylcholine binding, which results in skeletal muscle relaxation and paralysis.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C061870
SnomedCT 334060005, 108450002
English Pyrrolidinium, 1-((2beta,3alpha,5alpha,16beta,17beta)-17-(acetyloxy)-3-hydroxy-2-(4-morpholinyl)androstan-16-yl)-1-(2-propenyl)-, Bromide, muscle relaxants skeletal rocuronium bromide, rocuronium bromide (medication), ROCURONIUM BROMIDE, rocuronium bromide, Rocuronium bromide, Rocuronium bromide (substance), Rocuronium bromide [dup] (substance), pyrrolidinium, 1-((2beta,3alpha,5alpha,16beta,17beta)-17-(acetyloxy)-3-hydroxy-2-(4-morpholinyl)androstan-16-yl)-1-(2-propenyl)-, bromide, Rocuronium Bromide
Spanish bromuro de rocuronio (sustancia), bromuro de rocuronio

Ontology: Rocuronium (C0209337)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C061870
SnomedCT 108449002, 372494005
LNC LP62278-4
English 1-(17-(acetoyl)-3-hydroxy-2-(4-morpholinyl)androstan-16-yl)-1-(2-propenyl)pyrrolidinium, ROCURONIUM, Rocuronium, Rocuronium (product), Rocuronium (substance), rocuronium
Spanish rocuronio (producto), rocuronio (sustancia), rocuronio, roncuronio (sustancia), roncuronio

Ontology: Zemuron (C0591463)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C061870
English zemuron, Zemuron, Organon Teknika brand of rocuronium bromide, Organon brand of rocuronium bromide

Ontology: Esmeron (C2825405)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH C061870
English Esmeron, Esmerone