ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Neuromuscular Blocker Pregnancy: C

Rocuronium

Brand names: Esmeron

Adult dose

Dose: RSI: 1.2mg/kg IV. Standard intubation: 0.6mg/kg IV
Route: IV
Frequency: Single dose
Max: 120mg
RSI: 1.2mg/kg provides intubating conditions within 60–90 sec. Standard dose 0.6mg/kg: onset 3 min, duration 30–40 min. Reversal: sugammadex 16mg/kg (RSI dose) or 4mg/kg (standard dose).

Paediatric dose

Dose: 0.6 mg/kg
Route: IV
Frequency: Single intubating dose
Max: 50mg
Concentration: 10 mg/ml
Paediatric weight-based calculator

Clinical pearls

  • Preferred over suxamethonium when hyperkalaemia risk, malignant hyperthermia history, or known neuromuscular disease.
  • Sugammadex (16mg/kg) reverses RSI dose rocuronium within 3 min — critical lifeline in CICO (cannot intubate, cannot oxygenate) scenario.
  • Keep sugammadex immediately accessible at every RSI. 200mg vials — adult RSI typically requires 4 vials (80kg patient).
  • At 1.2mg/kg: intubating conditions within 60 sec, duration 60–90 min. Plan for sustained ventilation.

Contraindications

  • Hypersensitivity to rocuronium or bromide
  • Myasthenia gravis (extreme sensitivity — use very low doses only if essential)

Side effects

  • Prolonged neuromuscular blockade
  • Anaphylaxis (rare — more frequent than suxamethonium)
  • Histamine release (rare — less than atracurium)
  • Bronchospasm

Interactions

  • Volatile anaesthetics: enhance and prolong block
  • Aminoglycosides: enhance and prolong block
  • Sugammadex: reversal — 16mg/kg for immediate RSI reversal

Monitoring

  • Neuromuscular monitoring (TOF)
  • clinical signs of recovery

Reference: BNFc; NICE BNF 84; DAS RSI Guidelines 2015; Difficult Airway Society. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Drugs
Pathways