Esmeron

Rocuronium Br

Adjunct to general anesth to facilitate tracheal intubation during routine & rapid sequence induction & to provide skeletal muscle relaxation during surgery. Adjunct in ICU to facilitate intubation & mechanical ventilation. Ped: Adjunct to general anesth to facilitate tracheal intubation during routine induction & to provide skeletal muscle relaxation during surgery in ped patients from newborn infants to adolescents.

Surgical procedures: Tracheal intubation Standard dose: 0.6 mg/kg. Rapid sequence induction of anesth: 1 mg/kg or 0.6 mg/kg (for those undergoing Cesarian section). Maintenance: 0.15 mg/kg. Long-term inhalation anesth: 0.075-0.1 mg/kg. Continuous infusion Loading dose: 0.6 mg/kg. Adult under IV anesth Infusion rate: 0.3-0.6 mg/kg/hr; under inhalation anesth 0.3-0.4 mg/kg/hr. Term newborn infant (0-28 days), infant (28 days-23 mth), childn (2-11 yr) & adolescent (12-18 yr) Recommended intubation dose during routine anesth & maintenance dose: Similar to adults. Continuous infusion rates in ped are the same as for adults (except for childn). Geriatric & patient w/ hepatic &/or biliary tract disease &/or renal failure Routine anesth: 0.6 mg/kg. Rapid sequence induction of anesth: 0.6 mg/kg. Maintenance: 0.075-0.1 mg/kg. Infusion rate: 0.3-0.4 mg/kg/hr. Obese patient w/ m.t. 30% ideal body wt Reduced dose taking into account ideal body wt. Intensive care procedures: Tracheal intubation Same dose w/ surgical procedures. Maintenance: Initially 0.6 mg/kg loading dose followed by a continuous infusion as soon as twitch height recovers to 10% or upon re-appearance of 1-2 twitches to train of 4 stimulation. Initial infusion rate for maintenance in adults: 0.3-0.6 mg/kg/hr during the 1st hr, may be decreased during the following 6-12 hr.

Hypersensitivity to rocuronium or Br ion.

Ventilatory support is mandatory during treatment until adequate spontaneous respiration is needed. Extubate only after the patient has recovered sufficiently from neuromuscular block. Factors which could cause residual curarization after extubation in the post-op phase (eg, geriatric patients ≥65 yr, DI or patient conditions). Anaphylactic reactions particularly in case of previous anaphylactic reactions to neuromuscular blocking agents. Monitor neuromuscular transmission throughout neuromuscular blocking agents use. Risk of death due to medication error. Conditions associated w/ prolonged circulation (eg, CV disease, old age, edematous state). Patients w/ neuromuscular disease or after poliomyelitis, myasthenia gravis or myasthenic (Eaton-Lambert) syndrome, obesity, burns. Hypokalemia, hypermagnesemia, hypocalcemia, hypoproteinemia, dehydration, acidosis, hypercapnia, cachexia. Correct severe electrolyte disturbances, altered blood pH or dehydration when possible. Surgery under hypothermic conditions. Patients receiving both neuromuscular agents & corticosteroids. Concomitant use w/ suxamethonium. Hepatic &/or biliary disease &/or renal failure. May affect ability to drive or operate machinery. Pregnancy & lactation. Childn (facilitating tracheal intubation conditions during rapid sequence induction; mechanical ventilation in the intensive care). Elderly (facilitating mechanical ventilation in the intensive care).

Inj site pain/reaction, changes in vital signs & prolonged neuromuscular block; anaphylactic & anaphylactoid reactions.

Increased effect w/ halogenated volatile anesth, suxamethonium (after intubation), corticosteroids (long-term use); antibiotics (aminoglycosides, lincosamide, polypeptide & acylamino-penicillin); diuretics, quinidine, quinine, Mg salts, Ca channel blockers, lithium salts, local anesth (lidocaine IV, epidural bupivacaine), acute administration of phenytoin or β-blockers. Recurarization after post-op administration w/ aminoglycoside, lincosamide, polypeptide & acylamino-penicillin, quinidine, quinine & Mg salts. Decreased effect w/ chronic administration of phenytoin or carbamazepine; PIs (gabexate, ulinastatin). Attenuated/potentiated neuromuscular blocking effect w/ other nondepolarizing neuromuscular blockers & suxamethonium. Quicker onset of lidocaine action.

Neuromuscular Blocking Agents

M03AC09 - rocuronium bromide ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.

Rx