Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Skeletal Muscle Relaxant
Original Date: 
April 2012
  • Induce muscle relaxation
  • Facilitate mechanical ventilation of appropriately sedated patients
  • Facilitate endotracheal intubation
  • IV direct: over 5 - 15 seconds
  • IV continuous infusion
  • IV direct: 0.45 - 0.6 mg/kg/dose Q20 - 30 min PRN
  • IV continuous infusion:  0.42 - 0.72 mg/kg/hr

Infant (corrected GA > 42 weeks and PNA > 4 weeks)

  • IV direct: 0.5 - 1 mg/kg/dose Q20 - 30 min PRN
  • IV continuous infusion: 0.42 - 0.72 mg/kg/hr
Side Effects: 
  • CVS: arrhythmias, hypertension, hypotension, tachycardia
  • GI: vomiting
  • Most frequent adverse effects are related to prolongation of pharmacologic actions


Parameters to Monitor: 
  • BP, HR, RR
  • Adequacy of ventilation via arterial blood gas
Reconstitution and Stability: 

* Refrigerated vials; Unopened vials are stable for 6 months at room temperature.  Diluted solutions are stable for 24 hours at room temperature.

For IV direct:

  • Rocuronium 10 mg/mL
    • Final concentration: 10 mg/mL (vial)
  • Rocuronium 10 mg/mL
    • Take 1 mL (10 mg) and add to 9 mL of 0.9% NaCl or D5W
    • Final concentration: 1 mg/mL

For continuous infusion:

  • Rocuronium 10 mg/mL
    • Take 2 mL (20 mg) and add to 18 mL of D5W
    • Final concentration: 1 mg/mL

- Solutions Compatible: D5W, 0.9% NaCl, dextrose-saline combinations

- Y-site Compatible: fentanyl, KCl, midazolam, milrinone, morphine

Incompatible: SMOF

  • Antidote = neostigmine 0.05 mg/kg IV plus atropine 0.02 mg/kg IV

- Feltman DM, Weiss MG, Nicoski P, Sinacore J.  Rocuronium for nonemergent intubation of term and preterm infants.  Journal of Perinatalogy (2011) 31, 38-43

- Johnson PN, Miller J, Gormley AK.  Continuous-Infusion Neuromuscular Blocking Agents in Critically Ill Neonates and Children.  Pharmacotherapy 2011;31(6):609-620

-Rapp H-J, Altenmueller CA, Waschke C.  Neuromuscular recovery following rocuronium bromide single dose in infants.  Pediatric anesthesia 2004;14: 329-335

- Taketomo CK, Hodding JH, Kraus DM,  Pediatric Dosage Handbook 17th Edition. Hudson; Lexi-Comp Inc.; 2010

- Trissel LA.  Handbook on Injectable Drugs 16th Edition. Bethesda: American Society of Health-System Pharmacists; 2011


The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.