rocuronium

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

Indication

  • Muscle relaxant/paralytic used as an adjunct to facilitate mechanical ventilation

Dosage Guidelines

  • 0.3-0.6 mg/kg/dose IV q30 minutes – q2 hours prn
  • 7-10 micrograms/kg/min IV continuous infusion
  • Dose depends on individual needs and response and must be adjusted accordingly

Administration

  • IV direct over 5-15 seconds   First dose must be given under MD/NP supervision
  • IV continuous infusion

  • For patients 2 kg or less: Use rocuronium 1 mg/mL

    To make 50 mL of rocuronium [1 mg/mL] solution:

    Add 5 mL (50 mg) of rocuronium [10 mg/mL] to 45 mL of solution

  • For patients over 2 kg: Use rocuronium 5 mg/mL

    To make 50 mL of rocuronium [5 mg/mL] solution:

    Add 25 mL (250 mg) of rocuronium [10 mg/mL] to 25 mL of solution

Adverse Effects

  • Hypoventilation, hypertension, transient hypotension, tachycardia
  • Joint contractures and muscle atrophy with prolonged use

Comments

  • REQUIRES CONSTANT NURSING SUPERVISION. Eye care with lubricating eye ointment q8 hours or drops q2 hours.  Bladder may need massaging q2-4 hours to empty.  Gentle flexion and extension of knee and ankle joints helps to prevent joint contractures.
  • Constant pCO2 and cardiorespiratory monitoring recommended
  • Analgesia and/or sedation required in paralyzed infants
  • Effects increased by acidosis, hypokalemia, hypothermia, renal or hepatic dysfunction and aminoglycosides
  • Effects decreased by hypercalcemia, hyperkalemia, EPINEPHrine, or alkalosis
  • Onset within 2 minutes. Duration 40 minutes
  • Ensure passive range of motion for all limb extremities and developmentally supportive positioning with body alignment
  • REVERSAL OF NEUROMUSCULAR BLOCKADE
  • neuromuscular blockade can be reversed by administering neostigmine (a cholinesterase inhibitor)
  • give atropine prior to neostigmine, to prevent vagal reaction (bradycardia, bronchospasm, increased salivation)
  • atropine 0.02 mg/kg (20 mcg/kg) IV direct over 30 seconds to 1 minute by MD/NP only
  • neostigmine 0.06 mg/kg IV direct over 30 seconds to 1 minute by MD only

Supplied As

  • 10 mg/mL 5mL vial (vial is refrigerated)
  • Supplied by Pharmacy as standard concentrations of 1 mg/mL (supplied as 0.4 mg/50 mL of IV fluid ordered) and 5 mg/mL (250 mg/50 mL of IV fluid ordered)
  • At LHSC, standard concentration reference charts are available on the NICU Intranet site

References

LexiComp Sick Kids, LexiComp Pediatric and Neonatal, Neofax