ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Non-Depolarising Neuromuscular Blocking Agent Pregnancy: Use with caution — safe for obstetric RSI

Rocuronium (Anaesthesia/RSI)

Brand names: Esmeron

Adult dose

Dose: RSI: 1.2 mg/kg; Intubation: 0.6 mg/kg; Maintenance: 0.1–0.2 mg/kg
Route: IV
Frequency: Bolus; repeat as required
Max: Titrated to TOF monitoring
At 1.2 mg/kg provides intubating conditions equivalent to suxamethonium at 90 sec. Unique advantage: fully reversible at any depth with sugammadex 16 mg/kg — preferred if CICO scenario anticipated.

Paediatric dose

Dose: 0.6 mg/kg
Route: IV
Frequency: Bolus
Max: Titrated to effect
Intubation: 0.6 mg/kg. RSI dose: 0.9–1.2 mg/kg. Onset faster in neonates and infants due to higher volume of distribution.

Dose adjustments

Renal

Caution — prolonged duration in renal failure (25% renal excretion). Monitor with TOF.

Hepatic

Prolonged duration in hepatic failure — reduce maintenance doses; use TOF monitoring.

Paediatric weight-based calculator

Intubation: 0.6 mg/kg. RSI dose: 0.9–1.2 mg/kg. Onset faster in neonates and infants due to higher volume of distribution.

Clinical pearls

  • Full reversal with sugammadex 16 mg/kg at any depth — this is the KEY advantage over suxamethonium in anticipated difficult airway (DAS cannot-intubate-cannot-oxygenate pathway)
  • DAS 2015: rocuronium 1.2 mg/kg + sugammadex 16 mg/kg is an accepted alternative to suxamethonium for RSI
  • TOF ratio >0.9 required before extubation — quantitative TOF monitoring mandatory per AAGBI

Contraindications

  • Hypersensitivity to rocuronium or bromide ion

Side effects

  • Anaphylaxis (NMBs are commonest cause of perioperative anaphylaxis)
  • Prolonged block in organ failure
  • Injection site pain

Interactions

  • Volatile anaesthetics (potentiate)
  • Aminoglycosides (potentiate)
  • Magnesium sulphate (potentiate — caution pre-eclampsia)
  • Ciclosporin (prolongs block)

Monitoring

  • Quantitative TOF monitoring throughout and before extubation
  • Clinical signs of residual blockade post-op

Reference: BNFc; BNF 90; DAS RSI Guidelines 2015; AAGBI Anaphylaxis Guidelines 2009; AAGBI TOF Monitoring Recommendations. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Drugs
Pathways