||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 hypothermia or mechanical ventilation with renal or hepatic dysfunction.
0.1 mg/kg bolus, then 5-10 mg/hour
(0.03 - 0.6 mg/kg/hour)
- 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
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
- 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:
- 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 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