Rocuronium

Quick Answer

Rocuronium is an aminosteroid non-depolarizing neuromuscular blocking agent (NMBA) with rapid onset (60-90 seconds) making it suitable for rapid sequence intubation (RSI) when succinylcholine contraindicated. Mechanism: Competitive antagonist at nicotinic acetylcholine receptors (nAChR) at neuromuscular junction, preventing depolarization and muscle contraction. Structure: Aminosteroid (four rings like steroid nucleus), quaternary ammonium compound (poor lipid solubility, does not cross blood-brain barrier or placenta). ED95: 0.3 mg/kg (dose producing 95% twitch depression). Intubating dose: 0.6 mg/kg (2× ED95) provides intubating conditions in 60-90 seconds; 1.2 mg/kg (4× ED95) for RSI provides conditions in 45-60 seconds comparable to succinylcholine. Duration: 20-35 minutes (intermediate acting), longer with higher doses. Metabolism: Minimal hepatic metabolism (deacetylation, 10-25%), primarily biliary excretion (70%), some renal excretion (10-30%). Reversal: Neostigmine 0.05 mg/kg IV with glycopyrrolate 0.01 mg/kg (anticholinergic); sugammadex 2-4 mg/kg IV for rapid reversal (encapsulates rocuronium). Context-sensitive half-time: Increases with infusion duration (25 min after 1 hour, 50 min after 4 hours). Side effects: Anaphylaxis (0.5-1% of cases, most common NMBA cause of anaphylaxis), vagolytic effect (tachycardia at high doses). Contraindications: Known hypersensitivity, myasthenia gravis (resistance to non-depolarizers), Eaton-Lambert syndrome (sensitivity). Indigenous considerations: Higher rates of renal impairment may prolong duration; adequate reversal verification essential. [1-10]