Neonatal Drug Therapy Manual

Rocuronium

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.

Updated January 26, 2022 - 6:00pm

Alternate Name(s): 
Zemuron
Classification: 
Skeletal Muscle Relaxant
Original Date: 
April 2012
Indications: 
  • Induce muscle relaxation
  • Facilitate mechanical ventilation of appropriately sedated patients
  • Facilitate endotracheal intubation
Administration: 
  • IV direct: over 5 - 15 seconds
  • IV continuous infusion
Dosage: 
  • 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
Compatibility: 

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

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

Incompatible: SMOF

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

- 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

 

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