||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)
|Single dose for procedure, mechanical ventilation or hypothermia
(round to nearest 10 mg)
Continuous infusion for hypothermia or mechanical ventilation
Continuous infusion for severe ARDS
||15 mg bolus followed by 37.5 mg/hr x 48 hours then stop or convert to rocuronium as required
- 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.
dose reductions may be indicated in hepatic insufficiency
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
- bradycardia or tachycardia
- hypertension or hypotension
- anaphylaxis- rash
- corneal ulceration
- excessive salivation
- 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
- anticholinesterase agents, e.g. neostigmine
- 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
- 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