These population-based estimates and a measure of the estimate variability are contained in the following section.Following intravenous administration of rocuronium bromide, plasma levels of rocuronium follow a three-compartment open model. Each mL contains 10 mg rocuronium bromide and 2 mg sodium acetate. The dosage information which follows is derived from studies based upon units of drug per unit of body weight. Doses of Rocuronium Bromide Injection should be individualized and a peripheral nerve stimulator should be used to monitor drug effect, need for additional doses, adequacy of spontaneous recovery or antagonism, and to decrease the complications of overdosage if additional doses are administered.Table 1. No data are available in such patients and no dosing recommendations can be made.Rocuronium bromide -induced neuromuscular blockade was modified by alkalosis and acidosis in experimental pigs.
Animal studies have indicated that the ratio of vagal:neuromuscular block following rocuronium bromide administration is less than vecuronium but greater than pancuronium.
Median (Range) Time to Onset and Clinical Duration Following Initial (Intubating) Dose during Opioid/Nitrous Oxide/Oxygen Anesthesia (Adults) and Halothane Anesthesia (Pediatric Patients)Table 6. Rocuronium bromide is chemically designated as 1-[17β-(acetyloxy)-3 α-hydroxy-2β-(4-morpholinyl)-5 α-androstan-16β-yl]-1-(2-propenyl)pyrrolidinium bromide. If these antibiotics are used in conjunction with rocuronium bromide, prolongation of neuromuscular block may occur.In 2 of 4 patients receiving chronic anticonvulsant therapy, apparent resistance to the effects of rocuronium bromide was observed in the form of diminished magnitude of neuromuscular block, or shortened clinical duration.
Under halothane, isoflurane, and enflurane anesthesia, some extension of the period of clinical relaxation should be expected [see A lower dose of rocuronium bromide (0.45 mg/kg) may be used. Mean (SD) Pharmacokinetic Parameters of Rocuronium in Pediatric Patients during Sevoflurane (induction) and Isoflurane/Nitrous Oxide (maintenance) Anesthesia13.1 Carcinogenesis, Mutagenesis, Impairment of FertilityWe comply with the HONcode standard for trustworthy health information - These findings are consistent with the increase in volume of distribution at steady state observed in patients with significant hepatic impairment [see Clinical Pharmacology (12.3)]. Data sources include IBM Watson Micromedex (updated 2 Sep 2020), Cerner Multum™ (updated 1 Sep 2020), Wolters Kluwer™ … Of the pediatric patients anesthetized with halothane who did not receive atropine for induction, about 80% experienced a transient increase (30% or greater) in heart rate after intubation. Patients with renal failure may have a greater variation in duration of effect [see In obese patients, the initial dose of rocuronium bromide 0.6 mg/kg should be based upon the patient’s actual body weight [see An analysis across all US controlled clinical studies indicates that the pharmacodynamics of rocuronium bromide are not different between obese and non-obese patients when dosed based upon their actual body weight.Rocuronium metabolism does not depend on plasma cholinesterase so dosing adjustments are not needed in patients with reduced plasma cholinesterase activity.Because higher doses of rocuronium bromide produce a longer duration of action, the initial dosage should usually not be increased in these patients to reduce onset time; instead, in these situations, when feasible, more time should be allowed for the drug to achieve onset of effect [see Warnings and Precautions (5.8)].The neuromuscular blocking action of rocuronium bromide is potentiated by isoflurane and enflurane anesthesia. The rapid distribution half-life is 1 to 2 minutes and the slower distribution half-life is 14 to 18 minutes. Rocuronium bromide is an aminosteroid non-depolarizing neuromuscular blocker or muscle relaxant used in modern anaesthesia to facilitate tracheal intubation by providing skeletal muscle relaxation, most commonly required for surgery or mechanical ventilation. In all cases, dosing should be guided based on the clinical duration following initial dose or prior maintenance dose and not administered until recovery of neuromuscular function is evident.