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What is Rocuronium
Rocuronium is a parenteral, intermediate-acting, nondepolarizing, neuromuscular blocking agent (NMBA) indicated as an adjunct to general anesthesia to facilitate both rapid-sequence and routine tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Rocuronium is an analog of vecuronium, developed out of the need for an agent with a rapid onset and short duration of action, as well as a low risk of side effects.
Although generally considered an intermediate-acting agent, at larger doses, the onset of action shortens.
Rocuronium’s onset of action is comparable to that of succinylcholine, and it is often considered an alternative for rapid sequence intubation (RSI).
Its duration of action is significantly longer than succinylcholine.
Rocuronium produces minimal histamine release and is less likely to cause bronchospasm or cardiac adverse effects than neuromuscular blockers with significant histamine-releasing properties such as succinylcholine or atracurium.
Brand Name
Zemuron
Indications
- endotracheal intubation
- neuromuscular blockade during mechanical ventilation
- neuromuscular blockade during surgery
- rapid-sequence intubation
- shaking chills
Side Effects
- acute quadriplegic myopathy syndrome
- anaphylactoid reactions
- angioedema
- anxiety
- apnea
- bronchospasm
- conjunctivitis
- dyspnea
- edema
- erythema
- flushing
- hiccups
- hypertension
- hypotension
- hypoxia
- injection site reaction
- keratitis
- malignant hyperthermia
- muscle paralysis
- myopathy
- nausea
- pruritus
- pulmonary hypertension
- QT prolongation
- rash
- respiratory depression
- sinus tachycardia
- skin erosion
- skin ulcer
- thrombosis
- tolerance
- urticaria
- vomiting
- weakness
- wheezing
- xerophthalmia
Monitoring Parameters
- peripheral nerve stimulation
Contraindications
- accidental exposure
- acid/base imbalance
- adrenal insufficiency
- apheresis
- ascites
- asthma
- AV block
- bradycardia
- breast-feeding
- bromide hypersensitivity
- burns
- cardiac disease
- cardiomyopathy
- celiac disease
- chronic lung disease (CLD)
- chronic obstructive pulmonary disease (COPD)
- dehydration
- edema
- electrolyte imbalance
- females
- fever
- geriatric
- heart failure
- hepatic disease
- human immunodeficiency virus (HIV) infection
- hypercalcemia
- hypermagnesemia
- hyperparathyroidism
- hypocalcemia
- hypokalemia
- hypomagnesemia
- hypothermia
- hypothyroidism
- infants
- inflammation
- labor
- long QT syndrome
- malignant hyperthermia
- metabolic acidosis
- metabolic alkalosis
- myasthenia gravis
- myocardial infarction
- neonates
- neuromuscular blocking agent hypersensitivity
- neuromuscular disease
- obesity
- obstetric delivery
- pheochromocytoma
- pregnancy
- pulmonary disease
- pulmonary hypertension
- QT prolongation
- renal failure
- requires a specialized care setting
- requires an experienced clinician
- respiratory acidosis
- respiratory alkalosis
- rheumatoid arthritis
- sickle cell disease
- sleep deprivation
- stroke
- systemic lupus erythematosus (SLE)
- valvular heart disease
Interactions
- Acebutolol
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Codeine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Propoxyphene
- Alfentanil
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Amide local anesthetics
- Aminoglycosides
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amphotericin B
- Amphotericin B cholesteryl sulfate complex (ABCD)
- Amphotericin B lipid complex (ABLC)
- Amphotericin B liposomal (LAmB)
- Apomorphine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atenolol
- Atenolol; Chlorthalidone
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Bacitracin
- Belladonna; Opium
- Bendroflumethiazide; Nadolol
- Benzhydrocodone; Acetaminophen
- Benzodiazepines
- Benzonatate
- Beta-blockers
- Betaxolol
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Botulinum Toxins
- Brimonidine; Timolol
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Calcium
- Calcium Acetate
- Calcium Carbonate
- Calcium Carbonate; Magnesium Hydroxide
- Calcium Carbonate; Risedronate
- Calcium Carbonate; Simethicone
- Calcium Chloride
- Calcium Gluconate
- Calcium-channel blockers
- Calcium; Vitamin D
- Capreomycin
- Carbamazepine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbonic anhydrase inhibitors
- Carteolol
- Carvedilol
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chromium
- Clevidipine
- Clozapine
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Colistimethate, Colistin, Polymyxin E
- Corticosteroids
- Cyclophosphamide
- Cyclosporine
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Demeclocycline
- Desflurane
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diltiazem
- Diphenhydramine; Hydrocodone; Phenylephrine
- Donepezil
- Donepezil; Memantine
- Dorzolamide; Timolol
- Doxycycline
- Enalapril; Felodipine
- Enflurane
- Esmolol
- Ester local anesthetics
- Felodipine
- Fentanyl
- Fosphenytoin
- Galantamine
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Hetastarch; Dextrose; Electrolytes
- Homatropine; Hydrocodone
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Ibuprofen; Oxycodone
- Indapamide
- Irinotecan
- Irinotecan Liposomal
- Isoflurane
- Isradipine
- Ketorolac
- Labetalol
- Levobetaxolol
- Levobunolol
- Levomethadyl
- Levorphanol
- Lincosamides
- Lithium
- Loop diuretics
- Lopinavir; Ritonavir
- Magnesium
- Mepenzolate
- Meperidine
- Meperidine; Promethazine
- Methadone
- Methohexital
- Metoprolol
- Minocycline
- Morphine
- Morphine; Naltrexone
- Nabilone
- Nadolol
- Nalbuphine
- Nebivolol
- Nebivolol; Valsartan
- Neostigmine
- Nicardipine
- Nifedipine
- Nimodipine
- Nisoldipine
- Omadacycline
- Ombitasvir; Paritaprevir; Ritonavir
- Oxycodone
- Oxymorphone
- Penbutolol
- Perindopril; Amlodipine
- Phenylephrine; Promethazine
- Phenytoin
- Physostigmine
- Pindolol
- Piperacillin
- Piperacillin; Tazobactam
- Polymyxin B
- Polymyxins
- Procainamide
- Promethazine
- Propoxyphene
- Propranolol
- Pyridostigmine
- Quinidine
- Quinine
- Ranitidine
- Remifentanil
- Ritonavir
- Rivastigmine
- Sarecycline
- Sedating H1-blockers
- Sevoflurane
- Skeletal Muscle Relaxants
- Sotalol
- Succinylcholine
- Sufentanil
- Tapentadol
- Tetracycline
- Tetracyclines
- Theophylline, Aminophylline
- Thiazide diuretics
- Thiopental
- Timolol
- Trandolapril; Verapamil
- Vancomycin
- Verapamil
