Rocuronium is used as an adjunct to general anesthesia to achieve relaxation of skeletal muscles during surgery and to facilitate tracheal intubation in patients of all ages (from term infants, adolescents, up to adults). In adults it is also indicated as an adjunct in the intensive care unit, for example to facilitate intubation for short-term use.
What is Rocuronium?
Rocuronium is a muscle relaxant drug, defined more precisely as "competitive non-depolarizing neuromuscular blocking type steroid". It is also known as "competitive neuromuscular blocker", these drugs act on the peripheral nervous system, interrupting the neuromuscular transmission by competing with the activity of the neurotransmitter acetylcholine, and thus reducing the response of acetylcholine receptors released after the nervous impulse.
In turn non-depolarizing neuromuscular blocking agents are chemically divisible into two categories: steroids (Rocuronium, Rapacuronium, Pipecuronium, Pancuronium, Vecuronium) and isoquinoline derivatives (tubocurarine, doxacurium, atracurium, cisatracurium, mivacurium).
How should Rocuronium be taken?
Rocuronium is commercially available in the form of solutions for injections, specifically designed for intravenous use in the form of bolus injection or continuous infusion.
Side effects associated with Rocuronium
There are several adverse effects that may result from the use of this drug, including:
- General disorders: allergic reactions;
- Cardiovascular disorders: hypotension, hypertension, vasodilation, tachycardia, bradycardia, and hypoxemia;
- Respiratory disorders: dyspnea, bronchospasm, laryngospasm, and asthma;
- Musculoskeletal disorders: muscle weakness;
- Dermatological disorders: rash, urticaria , reactions at the injection site
Contraindications and warnings associated with the use of Rocuronium
Particular attention should be paid when administering this drug to patients with known or suspected hypersensitivity to the product. Thus, this drug should only be administered by experienced staff.
Similar to all other neuromuscular blocking agents, the dosage of rocuronium should be individualized for each patient.
Some conditions – mostly due to severe electrolyte disturbances, altered blood pH or dehydration – can increase the effects of this drug and may include: hypokalemia, hypermagnesemia, hypocalcaemia, hypoproteinaemia, dehydration, acidosis, hypercapnia, cachexia.
Moreover, medical personnel should approach with caution before administrating the drug to patients who are taking any other concomitant medications. Some drugs, in fact – as the volatile halogenated anesthetics, corticosteroids, different types of antibiotics, diuretics and beta-blockers – can increase the effects; while concomitant use of other substances – such as phenytoin and carbamazepine – usually tend to reduce efficacy. The administration of other non-depolarizing neuromuscular blocking agents in combination with Rocuronium may produce attenuation or enhancement of the neuromuscular block, depending on the order of administration and the neuromuscular blocking agent used.
It is important to use caution when administrating the drug to pregnant women. In cases of breast-feeding, studies conducted to date have shown a Rocuronium accumulation in insignificant amounts of breast milk during lactation, therefore the use of the drug is allowed based on the judgment of the treating physician.
