Rocuronium Bromide (Zemuron)

Anesthesia Implications

Classification: Non-depolarizing neuromuscular blocker
Therapeutic Effects: Muscle relaxation
Time to Onset: 1 to 2 min (Higher doses of 1.0-1.2 mg/kg produce a faster onset of ~1 min)

Duration: 20 to 35 min

Contraindications

Renal or hepatic dysfunction

Allergic reaction to rocuronium

Alert (non-sedated) patients

Primary Considerations

Defasciculating – Rocuronium can be utilized to reduce/eliminate fasciculations.

Fast acting – this is one of the great advantages of rocuronium.

Reversible – another big advantage of rocuronium is fast reversibility with suggamadex. This is a distinct enough advantage that rocuronium can be used in emergency situations to facilitate difficult intubation where succinylcholine is unavailable or contraindicated.

Prolongation – rocuronium can be prolonged by hypothermia, hypovolemia, volatile inhaled agents (sevoflurane, desflurane, etc.), and renal and hepatic diseases

Blood pressure – the literature states that rocuronium has no effect on blood pressure. By clinical experience, rocuronium lowers blood pressure fairly profoundly.

IV push dose

Intubation – 0.6 to 1.2 mg/kg. Higher doses (1.0-1.2 mg/kg) produce faster onset times of ~1 min (similar to succinylcholine).

Defasciculating – 1/10th the intubating dose.  Clinically, it is usually ~ 5mg.

Obese – use LEAN body weight

Method of Action

Rocuronium acts on the post junctional nicotinic receptors at the neuromuscular junction by blocking acetylcholine.

Metabolism

Rocuronium is excreted unchanged in bile and about 30 % renal excretion.

Additional Notes
Blood-Brain Barrier – Rocuronium does NOT cross the blood brain barrier

OB – Rocuronium does NOT cross the placenta.

Jain. Rocuronium. StatPearls. 2020 web link