#高警訊藥品

肌肉鬆弛劑 Neuromuscular blockade for endotracheal intubation, surgery, or mechanical ventilation

Neuromuscular Blocker Agent
Blocks acetylcholine from binding to receptors on motor endplate inhibiting depolarization

Onset of action:
(Children) 30 seconds to 1 minute; (Adults) 1 to 2 minutes (depending on dose administered)
Duration:
(Infants) 40 minutes; (Children) 26 to 30 minutes; (Adults) ~30 minutes; hypothermia may prolong the duration of action
Distribution:
1. Vd: (General) 0.2 to 0.3 L/kg; (Hepatic dysfunction) 0.53 L/kg; (Renal dysfunction) 0.34 L/kg
2. Protein binding: ~30%
Metabolism:
Minimally hepatic; metabolized to 17-desacetylrocuronium (5% to 10% activity of parent drug)
Half-life elimination:
1. Adults: 1.4 to 2.4 hours
2. Hepatic impairment: 4.3 hours
3. Renal impairment: 2.4 hours
Excretion:
Feces (31%); urine (26%)

Hypersensitivity (eg, anaphylaxis) to rocuronium, other neuromuscular-blocking agents, or any component of the formulation.

Rocuronium crosses the placenta; does not recommend use for rapid sequence induction during cesarean section

Information related to rocuronium use and breast-feeding has not been located.

Increased peripheral vascular resistance, tachycardia, hypertension, transient hypotension, anaphylaxis

Neuromuscular blockade for rapid sequence intubation:
(IV) 0.6 to 1.2 mg/kg
Neuromuscular blockade for tracheal intubation:
1. Initial: 0.45 to 0.6 mg/kg; administration of 0.3 mg/kg may also provide optimal conditions
2. Maintenance: 0.1 to 0.2 mg/kg; repeat as needed or a continuous infusion of 10 to 12 mcg/kg/minute only after recovery of neuromuscular function is evident; infusion rates have ranged from 4 to 16 mcg/kg/minute

Rapid sequence intubation:
(IV) 0.9 to 1.2 mg/kg; Lower doses of 0.6 mg/kg may resulted in prolonged onset time, shortened duration, and less favorable intubating conditions
Tracheal intubation, surgical:
1. Initial: (IV) 0.45 to 0.6 mg/kg
2. Maintenance for continued surgical relaxation: (Intermittent IV) 0.075 to 0.15 mg/kg, repeat as needed; (Continuous IV infusion) 7 to 12 mcg/kg/minute, the manufacturer recommends using the lower end of the dosing range for infants and the upper end for children 2-11 years of age

No dosage adjustment necessary.

No dosage adjustment provided in manufacturer's labeling.
1. Dosage reductions may be necessary in patients with liver disease (duration may be prolonged due to increased volume of distribution)
2. When rapid sequence intubation is required in adult patients with ascites, a dose on the higher end of the dosage range may be necessary to achieve adequate neuromuscular blockade.