Rocsur Special Precautions

Since Rocuronium Bromide Injection causes paralysis of the respiratory muscles, ventilator support is mandatory for patients treated with this drug until adequate spontaneous respiration is restored.
As with all neuromuscular blocking agents, it is important to anticipate intubation difficulties, particularly when used as part of a rapid sequence induction technique. Anaphylactic reactions can occur following the administration of neuromuscular blocking agents. Precautions for treating such reactions should always be taken. Particularly in the case of previous anaphylactic reactions to neuromuscular blocking agents, special precautions should be taken since allergic cross-reactivity to neuromuscular blocking agents has been reported.
In general, following long term use of neuromuscular blocking agents in the ICU, prolonged paralysis and/or skeletal muscle weakness has been noted. In order to help preclude possible prolongation of neuromuscular block and/or overdosage it is strongly recommended that neuromuscular transmission is monitored throughout the use of muscle relaxants. In addition, patients should receive adequate analgesia and sedation. Furthermore, muscle relaxants should be titrated to effect in the individual patients by or under supervision of experienced clinicians who are familiar with their actions and with appropriate neuromuscular monitoring techniques.
The following conditions may influence the pharmacokinetics and/or pharmacodynamics of Rocuronium Bromide Injection: Hepatic and/or biliary tract disease and renal failure: Because Rocuronium is excreted in urine and bile, Rocuronium Bromide Injection should be used with caution in patients with clinically significant hepatic and/or biliary diseases and/or renal failure.
In these patient groups prolongation of action has been observed with doses of 0.6 mg Rocuronium bromide per kg body weight.
Prolonged circulation time: Conditions associated with prolonged circulation time such as cardiovascular disease, old age and oedematous state resulting in an increased volume of distribution, may contribute to a slower onset of action.
Neuromuscular disease: Like other neuromuscular blocking agents, Rocuronium Bromide Injection should be used with extreme caution in patients with a neuromuscular disease or after poliomyelitis since the response to neuromuscular blocking agents may be considerably altered in these cases. The magnitude and direction of this alteration may vary widely. In patients with myasthenia gravis or with the myasthenic (Eaton-Lambert) syndrome, small doses of Rocuronium Bromide Injection may have profound effects and Rocuronium Bromide Injection should be titrated to the response.
Hypothermia: In surgery under hypothermic conditions, the neuromuscular blocking effect of Rocuronium Bromide Injection is increased and the duration prolonged.
Obesity: Like other neuromuscular blocking agents, Rocuronium Bromide Injection may exhibit a prolonged duration and a prolonged duration and a prolonged spontaneous recovery in obese patients, when the administered doses are calculated on actual body weight.
Burns: Patients with burns are known to develop resistance to non-depolarizing neuromuscular blocking agents. It is recommended that the dose is titrated to response.
Conditions which may increase the effects of Rocuronium Bromide Injection: Hypokalaemia (e.g. after severe vomiting, diarrhea and diuretic therapy), hypermagnesemia, hypocalcemia (after massive transfusions), hypoproteinemia, dehydration, acidosis, hypercapnia, cachexia. Severe electrolyte disturbances, altered blood pH or dehydration should therefore be corrected when possible.