Rocuronium bromide

How it works

It competitively antagonises acetylcholine at nicotinic receptors of the neuromuscular junction, preventing motor end-plate depolarisation and producing reversible skeletal muscle paralysis.

Prescribing in practice

• It causes paralysis without sedation or pain relief, so adequate anaesthesia and analgesia must always be ensured throughout its use to prevent awareness; its block can be rapidly reversed with sugammadex.
• It is a recognised cause of perioperative anaphylaxis among neuromuscular blocking agents, and resuscitation facilities must be immediately available.
• Its duration is prolonged in hepatic impairment and the elderly, and neuromuscular monitoring should confirm adequate recovery before extubation.

Monitoring

Monitor the depth and recovery of neuromuscular block with a peripheral nerve stimulator throughout anaesthesia.

Counselling the patient

• This drug temporarily relaxes the muscles for surgery and is given alongside drugs that keep the patient asleep and free of pain.
• Breathing is supported by a ventilator while the medicine is working.
• A dedicated reversal agent can be used to restore muscle strength when needed.

Evidence & guidelines

Rocuronium is a well-established intermediate-acting neuromuscular blocker, and sugammadex provides rapid, predictable reversal of its block in routine and emergency anaesthetic practice.