What is the intubating dose of Rocuronium (rocuronium)?

From the Guidelines

The intubating dose of rocuronium for rapid sequence intubation (RSI) is 0.9 to 1.2 mg/kg intravenously, as recommended by recent guidelines. This dose is supported by the most recent and highest quality study, which found that rocuronium at a dose of 0.9 to 1.2 mg/kg provides excellent intubating conditions [ 1 ]. For patients with significant cardiovascular disease, renal impairment, or hepatic dysfunction, consider using the lower end of the dosing range.

Key Points to Consider

• The choice of rocuronium as a muscle relaxant for RSI is based on its rapid onset of action and its suitability for patients with contraindications to succinylcholine [ 1 ].
• The availability of sugammadex to reverse rocuronium rapidly may have encouraged the use of rocuronium in some settings when a selective relaxant binding agent (SRBA) is available [ 1 ].
• Rocuronium's duration of action is approximately 30-40 minutes at the 0.6 mg/kg dose and 60-70 minutes at higher doses.
• The medication works by competitively binding to nicotinic acetylcholine receptors at the neuromuscular junction, preventing acetylcholine from binding and thus blocking muscle contraction.

Important Considerations

• Unlike succinylcholine, rocuronium doesn't cause hyperkalemia or malignant hyperthermia, making it suitable for patients with contraindications to succinylcholine.
• Recent guidelines from the European Society of Anaesthesiology and Intensive Care make a strong recommendation, based on a moderate level of evidence, for the use of a fast-acting muscle relaxant such as succinylcholine 1–2 mg kg-1 or rocuronium 0.9 to 1.2 mg kg-1 for RSII [ 1 ].

From the FDA Drug Label

2.2 Dose for Tracheal Intubation The recommended initial dose of rocuronium bromide injection, regardless of anesthetic technique, is 0.6 mg/kg. Neuromuscular block sufficient for intubation (80% block or greater) is attained in a median (range) time of 1 (0.4 to 6) minute(s) and most patients have intubation completed within 2 minutes.

The intubating dose of rocuronium is 0.6 mg/kg. This dose may provide 31 (15 to 85) minutes of clinical relaxation under opioid/nitrous oxide/oxygen anesthesia. A lower dose of 0.45 mg/kg may also be used, providing 22 (12 to 31) minutes of clinical relaxation under opioid/nitrous oxide/oxygen anesthesia. For rapid sequence intubation, a dose of 0.6 to 1.2 mg/kg can be administered. 2

From the Research

Intubating Dose of Rocuronium

The intubating dose of rocuronium is a topic of interest in the field of anesthesia. According to the studies, the recommended dose of rocuronium for rapid sequence intubation is:

• 0.6 mg/kg, as mentioned in the study by 3
• 0.6 mg/kg, as mentioned in the study by 4
• 1.0 mg/kg, as mentioned in the study by 5
• 1.2 mg/kg, as mentioned in the study by 6

Comparison with Succinylcholine

Rocuronium is often compared to succinylcholine, another muscle relaxant commonly used for rapid sequence intubation. The studies suggest that:

• Succinylcholine creates superior intubation conditions to rocuronium, as mentioned in the study by 6 and 7
• Rocuronium may be associated with fewer adverse effects, as mentioned in the study by 3
• The optimal dose of rocuronium for emergency airway management is not clear, as mentioned in the study by 5

Key Findings

Some key findings from the studies include:

• The rate of excellent intubating conditions was 46% with MgSO4-rocuronium and 45% with saline-succinylcholine, as mentioned in the study by 3
• The incidence of oxygen desaturations did not differ between succinylcholine and rocuronium, as mentioned in the study by 4
• Rocuronium dosed ≥1.4 mg/kg was associated with higher first-attempt success when using direct laryngoscopy, as mentioned in the study by 5