What is the typical duration of action of rocuronium (non-depolarizing neuromuscular blocking agent) in a general adult population with normal renal and liver function?

Duration of Action of Rocuronium

In adults with normal renal and hepatic function, a standard intubating dose of rocuronium 0.6 mg/kg lasts approximately 30-45 minutes, with clinical duration extending to about 42 minutes under opioid/nitrous oxide/oxygen anesthesia. 1

Standard Dosing Duration

Single Bolus Administration

• Clinical duration after 0.6 mg/kg rocuronium is approximately 34-42 minutes, depending on the anesthetic technique used 1

  • Under opioid/nitrous oxide/oxygen anesthesia: 34 minutes 1
  • Under enflurane anesthesia: 38 minutes 1
  • Under isoflurane anesthesia: 42 minutes 1

• The median clinical duration (time to 25% recovery of T1) after 0.6 mg/kg is 36 minutes under balanced anesthesia 2

• Recovery to 90% of baseline twitch height occurs at approximately 45 minutes after 0.6 mg/kg 2

• Complete recovery (TOF ratio ≥0.7) typically occurs at 54-58 minutes after 0.6 mg/kg 2

Higher Dose Duration

• With 0.9 mg/kg rocuronium, clinical duration extends to 49-52 minutes (time to 25% T1 recovery) 2

• Complete recovery with 0.9 mg/kg occurs at approximately 72-79 minutes 2

Reduced Dose Duration

• A lower dose of 0.4 mg/kg produces a shorter clinical duration of approximately 21 minutes 3

Continuous Infusion Recovery Time

After stopping a continuous infusion of rocuronium, TOF response typically returns at approximately 60 minutes, though this parallels the recovery expected from equivalent total bolus exposure 4, 1

Factors That Prolong Duration

Inhalational Anesthetics

• Potent inhalation agents (isoflurane, enflurane) can prolong duration by up to 40% during continuous infusion 1
• The potentiation effect is minimal when rocuronium is administered before starting inhalational agents 1

Hepatic Impairment

• Clinical duration increases approximately 1.5-fold in patients with hepatic disease, with median duration of 60 minutes (range 35-166 minutes) compared to 42 minutes in normal patients 1
• Recovery time is also prolonged to a median of 53 minutes versus 20 minutes in normal hepatic function 1

Renal Impairment

• Duration is generally not prolonged in renal dysfunction, though substantial individual variability exists (range: 22-90 minutes) 1

Geriatric Patients

• Slightly prolonged median clinical duration of 46 minutes after 0.6 mg/kg (range 22-73 minutes) 1

Critical Monitoring Considerations

• Quantitative neuromuscular monitoring must be used to assess recovery, targeting a TOF ratio ≥0.9 before extubation 4

• The recovery index (time from 25% to 75% T1 recovery) is approximately 11 minutes after 0.6 mg/kg 3

• Rocuronium is classified as an intermediate-acting neuromuscular blocking agent, with duration similar to vecuronium 5, 6