GasGasGas - The FRCA Primary Exam Podcast GasGasGas - Rocuronium
Jul 25, 2024
Discover the fascinating world of rocuronium, a non-depolarising neuromuscular blocker. Learn about its pharmacodynamics and pharmacokinetics, including clearance in organ disease and dosing tips for both routine intubation and rapid sequence induction. Delve into the critical side effects and the risk of anaphylaxis, along with management strategies. Practical advice on choosing rocuronium versus alternatives and the importance of monitoring neuromuscular blockade will keep you informed and engaged!
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Pharmacology Snapshot
- Rocuronium is a non-depolarising amino-steroid muscle relaxant with rapid onset and liver-dominant elimination.
- It is water soluble, 30% protein bound, and has a low volume of distribution (0.27 L/kg).
Practical Dosing Tips
- Use 1–1.2 mg/kg for RSI and 0.6 mg/kg for standard intubation, and consider 100 mg as a pragmatic RSI dose.
- Target lean body weight in morbid obesity because rocuronium has low volume of distribution and limited fat uptake.
Competitive Mechanism Matters
- Rocuronium is competitive at the nicotinic receptor, meaning receptor occupancy depends on relative concentrations.
- This competition underpins reversal strategies using agents that alter receptor occupancy or bind rocuronium.