Rocuronium

Rocuronium bromide is a nondepolarizing neuromuscular blocking agent of the aminosteroid class used to produce skeletal muscle relaxation during anesthesia, especially to facilitate endotracheal intubation and provide muscle relaxation for surgery. It works by competitively binding to nicotinic acetylcholine receptors at the neuromuscular junction, preventing acetylcholine from depolarizing the motor endplate.

Onset after intravenous administration is typically 60 to 90 seconds, with a duration of about 30 to 60 minutes depending on the dose. Its rapid onset and titratability make it a common choice for rapid sequence induction. Rocuronium is mainly eliminated by hepatic clearance with biliary excretion; only a small portion is excreted unchanged in urine. Desacetyl rocuronium is a metabolite with relatively little activity.

Indications include induction of anesthesia with rapid onset neuromuscular blockade for tracheal intubation and maintenance of muscle relaxation during surgery. Dosing for intubation is usually 0.6 to 1.2 mg/kg IV; for rapid sequence induction, 1.0 to 1.5 mg/kg. Additional maintenance doses of 0.1 to 0.2 mg/kg may be given as needed.

Reversal of rocuronium-induced blockade is most commonly achieved with sugammadex, which encapsulates the drug to rapidly restore neuromuscular function. Dosing depends on blockade depth (for example, around 2 mg/kg for moderate blockade and up to 4 mg/kg for deeper block). Neostigmine with an anticholinergic can be used in some situations but is slower and less predictable.

Common considerations include possible hypotension or bradycardia, rare anaphylaxis, and prolonged blockade in hepatic impairment or with certain drug interactions (aminoglycosides, calcium channel blockers, magnesium sulfate). Rocuronium is marketed under various brand names worldwide.