Rocuronium Kabi

Adjunct to general anaesth to facilitate tracheal intubation during routine sequence induction & provide skeletal muscle relaxation during surgery in adult & paed patients (from term neonates to adolescents 0 to <18 yr). Facilitate tracheal intubation during rapid sequence induction & as adjunct in ICU (eg, to facilitate intubation) for short-term use.

IV Administer as bolus inj or continuous infusion. Individualised dosage. Surgical intensive care procedures: Tracheal intubation Standard dose during routine anaesth: 0.6 mg/kg. Intubate patient 90 sec after administration if used for rapid sequence induction of anaesth. Rapid sequence induction of anaesth: 1 mg/kg. Maintenance dose: 0.15 mg/kg. Long-term inhalational anaesth: 0.075-0.1 mg/kg. Administer maintenance dose when twitch height has recovered to 25% of control twitch height, or when 2-3 responses to train-of-four stimulation (TOF) are present. Continuous infusion: Loading dose: 0.6 mg/kg. Infusion rate: Adjust to maintain twitch response at 10% of control twitch height or 1-2 responses to TOF stimulation. Infusion rate: Adult under IV anaesth 0.3-0.6 mg/kg/hr, under inhalational anaesth 0.3-0.4 mg/kg/hr. Patient undergoing caesarean section 0.6 mg/kg. Adolescent (12-17 yr), childn (2-11 yr), toddler (>3 mth to 2 yr), infant (28 days to 3 mth), & neonate (0-28 days) Recommended intubation dose during routine anesth & maintenance dose: Similar to adult. Infusion rate: Continuous infusion rates in ped are the same as adults (higher infusion rates for childn may be necessary). Geriatric & patient w/ hepatic &/or biliary tract disease &/or renal failure Routine anaesth: 0.6 mg/kg. Maintenance dose: 0.075-0.1 mg/kg. Infusion rate: 0.3-0.4 mg/kg/hr. Overwt & obese patient (weighing ≥30% above ideal body wt) Reduce dose based on lean body mass.

Hypersensitivity to rocuronium Br or Br ion.

Anaphylactic reactions; allergic cross-reactivity to neuromuscular blockers. Not to be administered until there is full recovery from neuromuscular blockade caused by suxamethonium. Mandatory ventilatory support until adequate spontaneous respiration is restored. Extubate only after patient has recovered sufficiently from neuromuscular block. Consider factors (eg, drug interactions or patient's condition) that could cause residual curarization after extubation in post-op phase; use of reversal agent (eg, sugammadex or acetylcholinesterase inhibitors) if not used as part of standard clinical practice especially in residual curarization cases. Residual curarization; malignant hyperthermia. Increased heart rate w/ dose levels >0.9 mg/kg; neuromuscular blocking effect & prolonged duration in surgery under hypothermic conditions; effects w/ hypokalaemia (eg, after severe vomiting, diarrhoea or diuretic therapy), hypermagnesaemia, hypocalcaemia (after massive transfusions), hypoproteinaemia, dehydration, acidosis, hypercapnia & cachexia. Prolonged paralysis &/or skeletal muscle weakness in long-term use; circulation time in patients w/ CV diseases, old age & oedematous state; duration & spontaneous recovery in obese patients. Patients w/ neuromuscular disease or after poliomyelitis. Development of resistance in patients w/ burns. Ensure patient is breathing spontaneously, deeply & regularly after anaesth. Monitor neuromuscular transmission throughout use. Give adequate analgesia & sedation. Correct severe electrolyte disturbances, altered blood pH or dehydration when possible. Myopathy may occur after long-term concurrent use w/ corticosteroids. Hepatic &/or biliary disease &/or renal failure. Not recommended to use potentially dangerous machinery or drive car during the 1st 24 hr after full recovery. Pregnancy & lactation. Childn. Elderly ≥65 yr (increased risk for residual neuromuscular block).

Inj site pain/reaction, changes in vital functions & prolonged neuromuscular block (skeletal muscle weakness & paralysis, myopathy). Anaphylactic & anaphylactoid reactions & associated symptoms.

Increased effect w/ halogenated volatile anaesth; high dose thiopental, methohexital, ketamine, fentanyl, γ-hydroxybutyrate, etomidate or propofol; other non-depolarizing neuromuscular blocking agents; suxamethonium; antibiotics eg, aminoglycosides, lincosamides (eg, lincomycin & clindamycin), polypeptide antibiotics, acylamino-penicillin antibiotics, tetracyclines, high dose metronidazole; diuretics, thiamine, MAOIs, quinidine & its isomer quinine, protamine, adrenergic blockers, Mg & lithium salts, Ca channel blockers, local anaesth (IV lidocaine, epidural bupivacaine); acute administration of phenytoin or β-blockers. Prolonged duration of neuromuscular block or myopathy w/ corticosteroids. Decreased effect w/ neostigmine, edrophonium, pyridostigmine, aminopyridine derivatives; prior chronic administration of corticosteroids, phenytoin or carbamazepine; noradrenaline, azathioprine, theophylline, CaCl, KCl; PIs (gabexate, ulinastatin). May produce attenuation or potentiation of neuromuscular block w/ other non-depolarizing neuromuscular blockers; suxamethonium. More instant effect of lidocaine. Recurarization w/ aminoglycoside, lincosamide, polypeptide & acylamino-penicillin antibiotics, quinidine, quinine & Mg salts.

Neuromuscular Blocking Agents

M03AC09 - rocuronium bromide ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.

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