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Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Rocuronium has a relatively rapid onset of action and, as such, represents the best non-depolarising neuromuscular blocking agent available for the facilitation of endotracheal intubation. It should be remembered, however, that its long duration of action might cause significant problems in the setting of a difficult airway where rapid endotracheal intubation is impossible.
Analgesia, sedation and emergency anaesthesia
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Rocuronium (1 mg/kg) should be used as the standard muscle relaxant in patients where difficult intubation is not anticipated. It has been demonstrated that a ‘quick-look assessment’ often identifies the group of patients in which most difficult laryngoscopies are likely to be encountered. If a difficult laryngoscopy is anticipated, then 2 mg/kg of suxamethonium should be used, and fentanyl must be omitted. Ongoing muscle relaxation is subsequently achieved with 0.6 mg/kg of rocuronium.
Neuromuscular care
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Ankur Khandelwal, Hemanshu Prabhakar
Rocuronium is approximately six to 10 times less potent than pancuronium and vecuronium, respectively. The usual intubating dose ranges from 0.6 to 1 mg/kg and the duration of action is similar to vecuronium. However, increasing the dosage of rocuronium from 0.6 mg/kg to 1.2 mg/kg shortens the onset time of complete NM block from 89 seconds to 55 seconds, but essentially doubles the clinical duration of recovery from 37 minutes to 73 minutes.2 Continuous infusion dosing ranges from 8 to 12 µg/kg/min. Rocuronium is eliminated primarily by the liver (>70%), with a small percentage (≈10%) eliminated in the urine. The putative metabolite, 17-desacetylrocuronium has not been detected in significant quantities.
Comparison of analgesic efficacy of ultrasound-guided erector spinae block with port site infiltration following laparoscopic cholecystectomy
Published in Egyptian Journal of Anaesthesia, 2023
Magdy Mohammed Mahdy, Essam Ezzat Abdelhakeem, Ayman Mohamed Fawzy, Mostafa Samy Abbas
Standard monitors were used, including noninvasive blood pressure, pulse oximetry, electrocardiography, temperature, and capnography. Fentanyl 1–2 µg/kg and Propofol 2 mg/kg were used to induce anesthesia. Rocuronium bromide 0.6 mg/kg was used to facilitate endotracheal intubation and maintain skeletal muscle relaxation during surgery with the aid of train of four. Oxygen-air mixture 40% and isoflurane were used to maintain anesthesia. To guarantee normocarbia, controlled ventilation with closed circuit is used. After induction of general anesthesia nasogastric or orogastric tube was used to deflate the stomach which was removed at end of surgery. Patients underwent the intervention in accordance with their group assignment after anesthesia induction and under strict aseptic conditions.
Comparison of the supraglottic airway device BlockBusterTM and laryngeal mask airway Supreme in anaesthetised, paralyzed adult patients: a multicenter randomized controlled trial
Published in Expert Review of Medical Devices, 2022
Xue Gao, Ju-Hui Liu, Chun-Mei Chen, Yong Wang, Zhong-Yu Wang, Chun-Ling Yan, Ming-Zhang Zuo, Yu Cao, Xin Qiao, Ya-Qi Huang, Pei-Chang Liu, Hui Zhang, Jia-Qiang Zhang, Jun-Mei Shen, Chao Li, Yi Wang, Yan-Yan Sun, Jian-Nan Song, Xi-Zhe Zhang, Yun-Long Zhang, Xiao-Ting Luo, Lu-Nan Wu, Ye Zhang, Li Shi, Yuan Zhang, Fu-Shan Xue, Ming Tian
The patient head was placed at a sniffing position, and preoxygenation was performed until an end-tidal oxygen concentration of 88–90% was reached. Then, general anesthesia was induced with intravenous midazolam (0.05 mg/kg), sufentanil (0.4 μg/kg), propofol (2 mg/kg), and neuromuscular blockade was provided with intravenous rocuronium 0.6 mg/kg. Three minutes after intravenous rocuronium, an assistant performed the jaw thrust and opened the mouth with both hands. The SAD insertion was carried out by the experienced anesthetists, who had previously used more than 50 LMA Supreme and 50 SAD BlockBusterTM before the study. The devices were advanced into the oropharynx along the hard palate until a significant resistance was felt. After the cuffs were inflated to achieve an intracuff pressure of 40 cmH2O using a pressure gauge (VBM, Medizintechnik GmbH, Germany), the device was connected to the breathing system of an anesthetic machine for mechanical ventilation. General anesthesia was maintained with intravenous infusion of propofol (6–8 mg/kg/h) and remifentanil (0.1–0.2 μg/kg/min). As needed, rocuronium was intravenously administered during surgery.
Prehospital Drug Assisted Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Jeffrey L. Jarvis, John W. Lyng, Brian L. Miller, Michael C. Perlmutter, Heidi Abraham, Ritu Sahni
RSI, RSA, and DSI use a sedative agent paired with a paralytic to achieve rapid relaxation of protective airway reflexes and to facilitate insertion of ET tube or supraglottic airway. Multiple studies have shown that the use of any paralytic has been associated with higher first-pass success rates when compared with sedation-only intubation (1, 77–83). The two most common agents used in for prehospital RSI are succinylcholine and rocuronium, however other agents, such as vecuronium, are used by some agencies. The optimal agent for prehospital DAAM is unclear. Succinylcholine was initially promoted for emergency use because its shorter duration of action would, theoretically, allow for more rapid return of spontaneous respirations in the case of failed intubation. Others have argued that the longer duration of rocuronium is beneficial because it allows for optimal muscle relaxation, facilitating ventilation between airway insertion attempts. Succinylcholine is associated with shorter time to desaturation when compared with rocuronium (84, 85). There is conflicting evidence concerning intubation success and mortality with succinylcholine and rocuronium (84, 86, 87). If using rocuronium, intubation success is higher when using larger doses (above 1.2 mg/kg) (88, 89).