Indications
- Neuromuscular blockade for rapid sequence intubation (RSI).
Neuromuscular blockade following endotracheal intubation:
– Rocuronium is administered if the patient shows clinically significant signs of moving
following intubation without RSI.
- Patient movement during cardiac arrest that is interferring with resuscitation, despite ketamine
administration, provided the patient has been intubated and the endotracheal tube position has
been confirmed with capnography.
Contraindications and cautions
Contraindications:
- Known severe allergy.
- Endotracheal tube position has not been confirmed by capnography (this does not apply if the indication is for RSI).
Cautions:
- A Predicted difficult intubation (this only applies if the indication is for RSI).
- If the indication is for neuromuscular blockade
following endotracheal intubation: - Chronic muscle weakness. Examples include
myasthenia gravis, motor neuron disease and muscular dystrophy. Rocuronium may cause
prolonged muscle weakness and should be withheld if possible. If rocuronium is administered the dose should be halved.
– An adult with a very poor prognosis. Examples include severe comorbidities requiring long- term care, unwitnessed cardiac arrest and cardiac arrest with a first rhythm of aystole.
Rocuronium should be withheld if possible because the patient is unlikely to benefit from
admission to an intensive care unit and may be extubated in the ED.
Action
Rocuronium is a neuromuscular
blocker. It antagonises (blocks)
nicotinic acetylcholine receptors
at the neuromuscular junction
(motor nerve end plates) of skeletal muscle. This results in the inability of skeletal muscles to contract.
Route
IV / IO
Dosages
Depends:
RSI:
2mg/kg
- Adult range from 100mg - 200mg however weight specific.
Maintenance or after ETI:
- depends but normally 50-100mg
Side effect
None.
Onset and duration
onset: 30-60 seconds. This is predominantly affected by cardiac output and will be prolonged if cardiac output is low.
Duration: 30-60 minutes.
