Core pharmacology

Class Group

Non-Depolarizing
Aminosteroid

Legacy Cicm Level

Level 1

Introduction

Aminosteroid

Indications Uses

1. to facilitate tracheal intubation during routine and modified rapid
sequence induction
2. for controlled ventilation.

Chemical Pharmaceutics

Monoquaternary

Presentation

Clear, colourless solution, 10mg/mL rocuronium bromide

Mechanism of action

ND-NMB acts as competitive antagonist →
competes with ACh for nAChR binding → blocks cholinergic transmission → muscle
relaxation (> 70% post-synaptic nAChR occupancy required to result in block)
ND-NMB also inhibits pre-synaptic ACh receptors →prevents enhancement of ACh
release → fade with repeated stimulation

Onset Peak Duration

Int @ 100 – 120s
RSI @ 60s
Duration 35mins

Adverse Effects Toxicity

HISTAMINE RELEASE
- None
EFFECT ON ANS
- Can be vagolytic (↑HR)
OTHER
- Anaphylaxis
- Pain on injection

Distribution

Doesn’t cross BBB

Protein binding

PB 10%

Volume of distribution

VD 0.2L/kg

Metabolism

<5% Metabolism Hep

Excretion

Renal: 30-40%
Liver: 60%

Clearance

Pl cl: 3ml/kg/min

Half-life

El t1/2: 90mins

Special Points

Duration prolonged by:
- ↓K ↓Ca ↑Mg
- ↑pH ↑PaCO2
- ↓temp ↓protein Dehydration

Reversible with sugammadex

Route And Dose

ED95 0.3 mg/kg
Int 0.6 mg/kg
RSI 0.9 ~ 1.2 mg/kg
Inf 9 – 12 mcg/kg/min