From the Guidelines
Rocuronium does not typically cause bradycardia, and its administration is more likely to result in tachycardia due to its vagolytic actions. As a non-depolarizing neuromuscular blocking agent, its primary action is on skeletal muscles, not the heart 1. The study by Murray et al. in 2016 notes that rocuronium has an affinity for vagal receptors, thereby inhibiting vagal activity and can cause tachycardia in up to 30% of patients 1.
Key Points to Consider
- Rocuronium's vagolytic actions are most prominent, resulting in mild and dose-dependent tachycardia 1.
- Bradycardia can occur during the process of intubation, which often follows rocuronium administration, usually due to vagal stimulation from laryngoscopy rather than a direct effect of rocuronium.
- If bradycardia occurs, it's more likely due to other factors such as vagal stimulation, pre-existing cardiac conditions, or the effects of other medications used during anesthesia.
- Monitoring heart rate closely during induction and intubation is standard practice to quickly address any cardiovascular changes.
Management of Bradycardia
In cases where bradycardia does occur, atropine remains the first-line drug for acute symptomatic bradycardia, with a recommended dose of 0.5 mg IV every 3 to 5 minutes to a maximum total dose of 3 mg 1. However, the primary concern with rocuronium administration is not bradycardia but rather its potential to cause tachycardia, emphasizing the need for careful patient monitoring during its use.
From the FDA Drug Label
Hemodynamics There were no dose-related effects on the incidence of changes from baseline (30% or greater) in mean arterial blood pressure (MAP) or heart rate associated with rocuronium bromide administration over the dose range of 0.12 to 1. 2 mg/kg (4 x ED95) within 5 minutes after rocuronium bromide administration and prior to intubation. Increases or decreases in MAP were observed in 2% to 5% of geriatric and other adult patients, and in about 1% of pediatric patients. Heart rate changes (30% or greater) occurred in 0% to 2% of geriatric and other adult patients.
Tachycardia (30% or greater) occurred in 12 of 127 pediatric patients Most of the pediatric patients developing tachycardia were from a single study where the patients were anesthetized with halothane and who did not receive atropine for induction
Rocuronium and Bradycardia: There is no direct information in the provided drug labels that supports the occurrence of bradycardia (abnormally slow heart rate) as an effect of rocuronium administration. The information provided discusses changes in heart rate, including tachycardia, but does not mention bradycardia. Therefore, based on the provided drug labels, no conclusion can be drawn regarding the potential of rocuronium to cause bradycardia 2.
From the Research
Rocuronium and Bradycardia
- There is no direct evidence from the provided studies that rocuronium causes bradycardia (abnormally slow heart rate) 3, 4, 5, 6, 7.
- A study from 1994 found no statistically significant hemodynamic effects, including heart rate, after administration of rocuronium 4.
- Another study from 2021 found that the incidence of bradycardia was not significantly different among groups receiving nalbuphine, lidocaine, or saline before rocuronium injection 6.
- A study from 1999 found that elderly coronary artery bypass graft patients with left ventricular dysfunction were hemodynamically stable after two different doses of rocuronium, with no significant changes in heart rate 7.
- A study from 2024 found that rocuronium had positive signals for "cardiac disorders" but did not specifically mention bradycardia as an adverse event 5.