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 severe ARDS

Cisatracurium 15 mg bolus followed by 37.5 mg/hr x 48 hours then stop or convert to rocuronium as required
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:

    • 0.6-0.72mg/kg/hr

dose reductions may be indicated in hepatic insufficiency


Administration: IV Infusion:
50 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
Adverse Effects:
  • bradycardia or tachycardia
  • hypertension or hypotension
  • bronchospasm
  • anaphylaxis- rash
  • hypothermia
  • corneal ulceration
  • excessive salivation
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 accummulate in patients with renal dysfunction
Antidote:
  • anticholinesterase agents, e.g. neostigmine
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 
Monitoring Therapy:
  • continuous heart rater and rhythym
  • 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.
Adult Critical Care Protocol:
  • 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 mayadminister 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

 


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: September 20, 2018

LHSCHealth Professionals

Last Updated September 20, 2018 | © 2007, LHSC, London Ontario Canada