Rocuronium
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|Non-invasive ventilation (NIV)
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💉 Rocuronium is a non-depolarising muscle relaxant widely used in rapid sequence induction (RSI).
It has a longer duration of action than suxamethonium but can be reversed quickly with sugammadex, which makes it a popular choice in modern anaesthetic and emergency practice.
📖 About
- Always check the BNF link here for up-to-date prescribing advice.
- Most commonly used non-depolarising relaxant for RSI.
- Unlike suxamethonium, does not cause fasciculations or a rise in potassium.
⚙️ Mode of Action
- Competitive antagonist at nicotinic acetylcholine receptors at the neuromuscular junction.
- Prevents depolarisation of the muscle endplate → flaccid paralysis.
- Effect reversed by sugammadex (specific reversal) or by standard anticholinesterases (less effective).
💊 Indications/Dose
- Adults: 0.6 mg/kg IV for intubation. Maintenance 0.15 mg/kg IV bolus or 0.3–0.6 mg/kg/hour IV infusion (titrate to response).
- Elderly: Initially 0.6 mg/kg IV. Maintenance 0.075–0.1 mg/kg bolus, or up to 0.4 mg/kg/hour by infusion (adjust as needed).
🔗 Interactions
- See BNF for full list (notably potentiated by certain antibiotics, anaesthetic agents, and electrolyte disturbances).
⚠️ Cautions
- Burns patients (may show resistance).
- Cardiac disease and electrolyte disturbances.
- Hypothermia (prolongs effect).
- Myasthenia gravis (marked sensitivity).
⛔ Contraindications
- See BNF for full list (generally avoid in known hypersensitivity).
💥 Side Effects
- Flushing, hypotension, tachycardia.
- Bronchospasm, hypersensitivity (rare anaphylaxis in theatre).
- Skin reactions.
💡 Clinical Pearls
- Onset of action: ~1–2 minutes (slower than suxamethonium but adequate for RSI).
- Duration: 30–60 minutes (vs 5–10 minutes with suxamethonium).
- Preferred in patients with hyperkalaemia, burns, cord injury, or risk of malignant hyperthermia where suxamethonium is contraindicated.
- Sugammadex allows rapid reversal, making rocuronium safer for unanticipated difficult airways.
📚 References
