Recommended Dosage of Rocuronium for Intubation

The recommended dose of rocuronium for intubation is 0.6 mg/kg for routine intubation and 0.9-1.2 mg/kg for rapid sequence intubation. 1

Standard Dosing Recommendations

The FDA-approved initial dose of rocuronium for tracheal intubation is 0.6 mg/kg, which provides sufficient neuromuscular blockade for intubation in most patients within 1-2 minutes 1
With this standard dose (0.6 mg/kg), maximum blockade is achieved in most patients in less than 3 minutes and provides approximately 31 minutes (range 15-85 minutes) of clinical relaxation under opioid/nitrous oxide/oxygen anesthesia 1
A lower dose of 0.45 mg/kg may be used when shorter duration of action is desired, providing approximately 22 minutes of clinical relaxation 1

For rapid sequence intubation (RSI), higher doses of 0.9-1.2 mg/kg are recommended to provide excellent intubating conditions in less than 2 minutes 1
Recent evidence suggests that doses ≥1.4 mg/kg may be associated with higher first-attempt success when using direct laryngoscopy, particularly in patients with pre-intubation hypotension 2
When rocuronium is used as an alternative to succinylcholine for RSI, a dose of at least 0.9 mg/kg is recommended to achieve comparable intubation conditions 3

For routine paralysis in pediatric patients, the recommended dose is 0.1 mg/kg 3
For intubation in pediatric patients, the recommended dose is 0.2 mg/kg 3
When used as an alternative to succinylcholine in pediatric rapid sequence induction, rocuronium should be dosed at >0.9 mg/kg 3

In patients receiving other sedatives or narcotics, lower doses of rocuronium may be sufficient 3
In patients with cardiovascular instability, standard doses of rocuronium (0.6 mg/kg) may still be used as it has minimal cardiovascular effects 4, 5

Administer rocuronium intravenously as a bolus injection 1
Neuromuscular block sufficient for intubation (80% block or greater) is typically attained within 1 minute after standard dosing 1
When using rocuronium, ensure that a peripheral nerve stimulator is available to monitor drug effect and need for additional doses 1
Always flush IV tubing with saline before administering rocuronium after other medications to avoid precipitation and obstruction of IV tubing 3

Maintenance doses of 0.1-0.2 mg/kg can be administered when recovery of neuromuscular function is evident (typically at 25% recovery of control T1) 1
For continuous infusion, an initial rate of 10-12 mcg/kg/min is recommended, with subsequent adjustments based on peripheral nerve stimulator monitoring 1

Rocuronium does not provide sedation, analgesia, or amnesia, so appropriate sedative/analgesic agents must be administered concurrently 3
When using high-dose rocuronium (≥0.9 mg/kg) for RSI, consider having sugammadex available for reversal if needed in a "can't intubate, can't ventilate" scenario 4
Personnel with skills in airway management must be present and prepared to respond when rocuronium is administered 3
Age-appropriate equipment for suctioning, oxygenation, intubation, and ventilation should be immediately available 3