Rocuronium

CONTINUOUS INFUSION (eMC section 4.2): give a loading dose of 0.6 mg/kg and, when the neuromuscular block starts to recover, start administration by infusion; adjust the rate to maintain twitch response at 10% of control twitch height or 1 to 2 responses to TOF. In adults under intravenous anaesthesia the required infusion rate ranges from 0.3–0.6 mg/kg/h; under inhalational anaesthesia 0.3–0.4 mg/kg/h. Continuous neuromuscular monitoring is essential as requirements vary between patients and with anaesthetic method. If 0.6 mg/kg is used for rapid sequence induction it is recommended to intubate 90 seconds after administration. Inhalational anaesthetics potentiate the block — for procedures longer than 1 hour give smaller maintenance doses at less frequent intervals or use lower infusion rates. CAESAREAN SECTION: use only 0.6 mg/kg (1.0 mg/kg has not been investigated in this group); in patients receiving magnesium salts for toxaemia of pregnancy reduce the dose and titrate to twitch response, as magnesium enhances neuromuscular blockade and may make reversal unsatisfactory. ELDERLY and patients with hepatic and/or biliary tract disease and/or renal failure: intubation 0.6 mg/kg, maintenance 0.075–0.1 mg/kg, infusion rate 0.3–0.4 mg/kg/h. OVERWEIGHT/OBESE (body weight 30% or more above ideal body weight): reduce doses taking lean body mass into account. INTENSIVE CARE: for tracheal intubation use the same doses as under surgical procedures. Dose levels higher than 0.9 mg/kg may increase heart rate (no maximum dose is stated in the SPC). Ventilatory support is mandatory until adequate spontaneous respiration is restored; administer only by staff experienced with neuromuscular blocking agents. Section 4.5 was not captured in the fetched extract. CROSS-CHECK ONLY (US labelling, different units — verify against the UK SPC): initial infusion rate 10 to 12 micrograms/kg/min, clinical trial range 4 to 16 micrograms/kg/min; rapid sequence intubation 0.6 to 1.2 mg/kg.

The eMC SPC gives no standalone paediatric per-kg figure; it states: 'For neonates (0–27 days), infants (28 days to 2 months), toddlers (3 months to 23 months), children (2–11 years) and adolescents (12 to ≤ 17 years) the recommended intubation dose during routine anaesthesia and maintenance dose are similar to those in adults. However, the duration of action of the single intubating dose will be longer in neonates and infants than in children.' For continuous infusion in paediatrics the infusion rates, with the exception of children, are the same as for adults; for children higher infusion rates might be necessary, so start at the same initial rate as adults and adjust to maintain twitch response at 10% of control twitch height or 1 or 2 responses to TOF during the procedure. Rocuronium is NOT recommended for facilitating tracheal intubation conditions during rapid sequence induction in paediatric patients — experience is limited. A meta-analysis of 11 paediatric studies (n = 704, up to 1 mg/kg) identified tachycardia as an adverse reaction at a frequency of 1.4%. Confirm the exact paediatric dose against a children's formulary. dosePerKg is left null deliberately — the SPC states the paediatric dose only by reference to the adult dose, not as an independent paediatric figure.