Esmeron

Rocuronium Br

Adjunct to general anesth to facilitate endotracheal intubation, to provide skeletal muscle relaxation & to facilitate mechanical ventilation in adults, childn & infants ≥1 mth. Adjunct in the ICU to facilitate mechanical ventilation as part of rapid sequence induction in adults.

IV (as bolus inj or continuous infusion). Individualized dosing. Surgical procedures: Tracheal intubation Routine anesth: 0.6 mg/kg. Rapid sequence induction: 1 mg/kg; during cesarean section: 0.6 mg/kg. Maintenance Recommended dose: 0.15 mg/kg. Long-term inhalational anesth: Reduce dose to 0.075-0.1 mg/kg. Maintenance doses should best be given when twitch height has recovered to 25% of control twitch height, or when 2-3 responses to train of 4 stimulation are present. Continuous infusion Loading dose: 0.6 mg/kg. Infusion rate: Adjust to maintain twitch response at 10% of control twitch height or to maintain 1-2 responses to train of 4 stimulation. Geriatric & patient w/ hepatic & biliary tract disease &/or renal failure Routine anesth/rapid sequence induction: 0.6 mg/kg. Maintenance: 0.075-0.1 mg/kg. Infusion rate: 0.3-0.4 mg/kg/hr. Intensive care procedures: Tracheal intubation Routine anesth: 0.6 mg/kg. Rapid sequence induction: 1 mg/kg. Maintenance Loading dose: 0.6 mg/kg followed by continuous infusion as soon as twitch height recovers to 10% or upon reappearance of 1-2 twitches to train of 4 stimulation. Infusion rate: Initially 0.3-0.6 mg/kg/hr during the 1st hr of administration to be decreased during the following 6-12 hr according to the individual response.

Hypersensitivity to rocuronium or to Br ion.

Possible anaphylactic reactions following administration. Mandatory ventilatory support for patients until adequate spontaneous respiration is restored. Anticipate intubation difficulties particularly when used as part of a rapid sequence induction technique. Possible residual curarization; extubate only after the patient has recovered sufficiently from neuromuscular block. Increased risk of residual neuromuscular block in geriatric patients. Monitor neuromuscular transmission throughout the use of neuromuscular blockers; patients should receive adequate analgesia & sedation. Limit the period of using neuromuscular blockers in patients receiving both neuromuscular blockers & corticosteroids. Delay the administration of Esmeron if suxamethonium is used for intubation. Confirm proper selection of intended product & avoid confusion w/ other inj soln present in critical care & other clinical settings. Hepatic &/or biliary tract disease; renal failure; conditions associated w/ prolonged circulation time (eg, CV disease, old age & oedematous state); neuromuscular disease or after poliomyelitis; myasthenia gravis or Eaton-Lambert syndrome; hypothermia; obesity; burns; hypokalaemia, hypermagnesemia, hypocalcemia, hypoproteinemia, dehydration, acidosis, hypercapnia, cachexia. Severe electrolyte disturbances, altered blood pH or dehydration should be corrected. May affect ability to drive or operate machinery. Pregnancy & lactation. Not recommended for facilitating tracheal intubation conditions during rapid sequence induction in ped patients. Not recommended for facilitating mechanical ventilation in the intensive care in ped & geriatric patients. Neonates (0-1 mth).

Inj site pain/reaction, changes in vital signs & prolonged neuromuscular block.

Increased effect w/ halogenated volatile anesth; suxamethonium; long-term concomitant use w/ corticosteroids. Possible recurarization after post-op administration w/ aminoglycoside, lincosamide, polypeptide & acylamino-penicillin antibiotics; quinidine, quinine & Mg salts. Diuretics, Ca channel blockers, lithium salts, local anesth (eg, lidocaine IV, bupivacaine epidural), acute administration of phenytoin or β-blockers. Decreased effect w/ prior chronic administration of phenytoin or carbamazepine; PIs (eg, gabexate, ulinastatin). May produce attenuation or potentiation of the neuromuscular block w/ other non-depolarizing neuromuscular blockers; suxamethonium. May result in a quicker onset of action of lidocaine.

Neuromuscular Blocking Agents

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

POM