Rocuronium
Zemuron
Aminosteroid non-depolarizing muscle relaxant
Competitive antagonist at the NMJ nicotinic receptor.
Indications
- •RSI alternative to sux
- •Maintenance paralysis
- •ICU paralysis
Dosing
| 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 | — |
Pharmacokinetics
Onset 60–90 sec (dose-dependent). Duration 30–45 min (intubation dose). Hepatic uptake + biliary > renal elimination.
Hemodynamic effects
Minimal (vagolytic at high doses).
Side effects
- !Anaphylaxis (~1:2,500)
- !Prolongation in hepatic dysfunction
Contraindications
- ×Known anaphylaxis to roc/vec
Reversal / antidote
Sugammadex 2–4 mg/kg (TOF reversal) or 16 mg/kg (immediate full reversal). Neostigmine works once T1 > 25%.
Clinical pearls
- ★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).
📊 Related teaching panels
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Other drugs in Muscle Relaxants & Reversals
- Succinylcholine
Acetylcholine receptor agonist at the NMJ; sustained depolarization → fasciculations → flaccid paralysis. Hydrolyzed by plasma cholinesterase.
- Sugammadex
Encapsulates rocuronium > vecuronium > pancuronium in 1:1 complex. No effect on cisatracurium, atracurium, sux.
- Cisatracurium
Competitive antagonist at the post-synaptic nicotinic ACh receptor at the neuromuscular junction. Single cis-cis isomer of atracurium (4× more potent, lower laudanosine production).
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