Adjunct to general anaesth to facilitate tracheal intubation during routine or rapid sequence induction & to provide skeletal muscle relaxation during surgery. Adjunct in ICU to facilitate intubation & mechanical ventilation.
IV (as bolus inj or continuous infusion) Individualized dosage. Neuromuscular blockade (intermediate duration) during surgery & intubation Adult, neonate & childn Initial dose: 0.6 mg/kg IV inj. Maintenance dose: 0.15 mg/kg or 0.3-0.6 mg/kg/hr IV infusion. Rapid sequence induction: 1 mg/kg. Elderly Initial dose: 0.6 mg/kg IV inj. Maintenance dose: 0.75-0.1 mg/kg or up to 0.4 mg/kg/hr IV infusion. Neuromuscular blockade (intermediate duration) during intensive careAdult Initial dose: 0.6 mg/kg dose is optional by IV infusion. Maintenance dose: 0.3-0.6 mg/kg/hr IV infusion for the 1st hr then adjusted according to response. Hepatic & renal impairment Initial dose: 0.6 mg/kg IV inj. Maintenance dose: 0.075-0.1 mg/kg IV inj or 0.3-0.4 mg/kg/hr continuous infusion.
Patients w/ hypersensitivity reaction under general anaesth should be tested for cross-sensitivity to other neuromuscular blockers. Mandatory ventilatory support for patients until adequate spontaneous respiration is restored. Rocuronium may increase the heart rate. Prolonged circulation time in conditions eg, CV disease, old age & oedematous state. Use w/ extreme caution in patients w/ neuromuscular disease or after poliomyelitis, myasthenia gravis or myasthenic (Eaton-Lambert) syndrome. Obesity, hypothermia, burns, hypokalemia (eg, after severe vomiting, diarrhoea or diuretic therapy), hypermagnesaemia, hypocalcaemia (after massive transfusions), hypoproteinaemia, dehydration, acidosis, hypercapnia & cachexia. Correct severe electrolyte disturbances, altered blood pH or dehydration when possible. Prolonged paralysis &/or skeletal muscle weakness in long term use. Monitor neuromuscular transmission during therapy. Extubate only after the patient has recovered sufficiently from neuromuscular block. Delay administration if suxamethonium is used for intubation. Consider use of reversal agent in cases where residual neuromuscular blockade may occur. Myopathy after long-term therapy in the ICU in combination w/ corticosteroids. Limit use in patients receiving both neuromuscular blocking agent & corticosteroid. Hepatic &/or biliary tract & renal failure. Pregnancy & lactation. Risk of residual neuromuscular blockade after extubation in the post-op phase in geriatric patients ≥65 yr & other factors (eg, drug interactions or patient condition).
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