| Name: | ROCURONIUM (ZemuronR) |
| Classification: | non-depolarizing neuromuscular blocker; skeletal muscle relaxant - used to facilitate mechanical ventilation
- reduces airway resistance/pressures
- reduces metabolic rate and O2 consumption
- used in the management of tetanus
- safe for use in patients with malignant hyperthermia
may be used to stop muscle activity during a seizure but has no anticonvulsant properties Table 1. Indications and Dosing of Neuromuscular Blockers (NMB’s) | Indications | Recommended NMB | Dose | | Single dose for procedure, mechanical ventilation or hypothermia | Rocuronium | 0.6-1.2 mg/kg
(round to nearest 10 mg) | | Continuous infusion for hypothermia or mechanical ventilation | Rocuronium | 0.5-0.7 mg/kg/hr | | Continuous infusion for hypothermia or mechanical ventilation with renal or hepatic dysfunction. | Cisatracurium | (0.03 - 0.6 mg/kg/hour) |
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| Dose: | - Bolus doses:
- It is recommended to calculate bolus dose using ideal body weight, NOT actual body weight.
- 0.6mg/kg IV direct
- Recommended maximum bolus dose is 100 mg.
IV Infusion: dose reductions may be indicated in renal insufficiency |
| Administration: | IV Infusion:
250 mg/50ml dextrose 5%, normal saline 0.9% or Ringer's Lactate syringe pump infusion - mechanical ventilation must be increased to provide full support prior to administration
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| Adverse Effects: | - bradycardia or tachycardia
- hypertension or hypotension
- bronchospasm
- anaphylaxis- rash
- hypothermia
- corneal ulceration
- excessive salivation
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| Caution: | - in history of asthma; allergies; myasthenia gravis, Eaton-Lambert, amyotrophic lateral sclerosis or other neuromuscular disease; respiratory acidosis, electrolyte imbalances
- Rocuronium is renally excreted and drug may accumulate in patients with renal dysfunction
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| Antidote: | - anticholinesterase agents, e.g. neostigmine
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| Drug Interactions: | - rocuronium + aminoglycosides = increased neuromuscular blocking effect
- rocuronium + steroids = possible increased risk of myopathy
- rocuronium + anticonvulsants = possible decreased effect of rocuronium
- rocuronium + clindamycin = increased neuromuscular blocking effect
- rocuronium + inhalational anaesthetics = increased neuromuscular blocking effect
- rocuronium+ amphotericin B = increased neuromuscular blocking effect
- rocuronium + quinidine = increased neuromuscular blocking effect
- rocuronium + hypokalemia = increased neuromuscular blocking effect
- rocuronium + magnesium salts = increased neuromuscular blocking effect
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| Monitoring Therapy: | - continuous heart rate and rhythm
- continuous blood pressure
- continuous End Tital Carbon Dioxide monitoring
- continuous oxygen saturation
- ventilator parameters and monitor alarms
- chest sounds
- blood gases
- renal function
- electrolytes
- temperature
- eyes - keep moist and closed
- skin/limb support
- Routine use of Train of four (T.O.F) is no longer required
NOTE: - Has no CNS effects, therefore, consider patients able to hear and comprehend.
- Has no analgesic or sedative properties; patients require continuous analgesic and sedative administration.
- Pupils and GI tract are not affected.
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| Adult Critical Care Protocol: | - Patient must be fully ventilated on a controlled mode before administration of initial dose of neuromuscular blockade.
- May be administered IV direct or by IV infusion by a nurse in Adult Critical Care providing that the patient is receiving full mechanical ventilation.
- A nurse in Adult Critical Care may administer the initial dose.
- Administration of anaesthetic dosing of analgesics and sedatives must PRECEED initiation of neuromuscular blocking agents.
- A continuous infusion of analgesics and sedatives must be administered with an infusion of neuromuscular blocking agents.
- Continuous infusion must be administered via an infusion pump.
- May be titrated by a nurse in Adult Critical Care.
- Patient requires placement of an arterial line to monitor BP.
- Patient requires End Tidal CO2 monitoring.
- Continuous infusions must be administered by infusion device with pump library enabled.
- A bedside sign alerting staff of neuromuscular blocker use must be displayed
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