Rocuronium

Zemuron

Aminosteroid non-depolarizing muscle relaxant

Competitive antagonist at the NMJ nicotinic receptor.

Indications

Context	Adult	Pediatric
Intubation	0.6 mg/kg IV (90 sec onset)	0.6 mg/kg IV
RSI dose	1.0–1.2 mg/kg IV (60 sec onset)	1.0–1.2 mg/kg IV (rescue with sugammadex 16 mg/kg if cannot intubate/ventilate)
Maintenance	0.1–0.2 mg/kg q30 min or 8–10 mcg/kg/min	—

Onset 60–90 sec (dose-dependent). Duration 30–45 min (intubation dose). Hepatic uptake + biliary > renal elimination.

Minimal (vagolytic at high doses).

Sugammadex 2–4 mg/kg (TOF reversal) or 16 mg/kg (immediate full reversal). Neostigmine works once T1 > 25%.

★1.2 mg/kg + sugammadex 16 mg/kg = sux-comparable RSI option without K⁺ risk.
★Less hepatic metabolism than vecuronium → preferred in ESRD.
★Wait for ≥2 twitches before extubation; quantitative TOF preferred (TOFR ≥ 0.9).