Indications
Rocuronium bromide is a muscle relaxant used during general anaesthesia to relax the muscles so that a breathing tube can be placed in the windpipe (intubation) and surgery can be done more easily. It is also used in intensive care to help patients on a breathing machine.
How It Works
Rocuronium is a non-depolarising neuromuscular blocker. It blocks the receptors on muscles that receive signals from nerves (acetylcholine receptors), so the muscles, including breathing muscles, become temporarily relaxed and cannot move. It does not cause sleep or pain relief, so it is always given with anaesthetic and pain medicines. Its effect can be reversed with Sugammadex or Neostigmine.
Dosage and Administration
Rocuronium is given only by an anaesthetist or trained doctor, by injection or infusion into a vein, in an operating theatre or intensive care unit with full breathing support available. The dose depends on body weight, the procedure and the patient’s condition, as prescribed.
Interactions
Inhaled anaesthetics, some antibiotics (such as Gentamicin and other aminoglycosides, Clindamycin and Polymyxins), Magnesium, Lithium, Quinidine and some diuretics can strengthen or prolong its effect. Long-term Phenytoin or Carbamazepine use can reduce its effect. Steroids given with it in intensive care may increase the risk of muscle weakness.
Contraindications
- Allergy to Rocuronium or bromide.
- It must never be given where breathing support and trained staff are not available.
Side Effects
Pain at the injection site, changes in heart rate and blood pressure, and prolonged muscle weakness can occur. Rarely, severe allergic reactions (anaphylaxis) or breathing muscle weakness after the operation happen.
Staff watch for these continuously. After surgery, tell the nurse or doctor at once if you have difficulty breathing, swallowing or speaking, or feel very weak.
Pregnancy and Lactation
It may be used for caesarean section and in pregnancy when the anaesthetist judges it appropriate. Only small amounts are likely to reach breast milk; the anaesthetist will advise on breastfeeding after surgery.
Precautions and Warnings
Use with care in liver or kidney disease, myasthenia gravis and other nerve-muscle disorders, low body temperature, burns and in elderly or obese patients. Muscle function is monitored and the effect is fully reversed before the patient breathes alone.
Overdose
Overdose causes prolonged paralysis and inability to breathe. Breathing is supported by machine and the effect is reversed with Sugammadex or Neostigmine.
Therapeutic Class
Non-depolarising neuromuscular blocker (skeletal muscle relaxant, anaesthesia adjunct).
Storage
Hospital product: store as directed on the pack, usually in a refrigerator at 2 to 8°C, do not freeze, out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.