Rocum

Up to 1 Month

There are insufficient data to support dose recommendations for the use of rocuronium bromide in neonates.

1 Month to 14 Years Old

Children (1-14 years) and infant (1-12 months) under halothane anesthesia manifest similar sensitivity to rocuronium bromide as adults. Onset of action is faster in infants and children than adults. Clinical duration is shorter in children than in adults.

18 Years Old and Above

Tracheal intubation:
The standard intubating dose during routine anesthesia is 0.6 mg rocuronium bromide per kg body weight, after which adequate intubation conditions are established within 60 seconds in nearly all patients. A dose of 1.0 mg/kg body weight is recommended for facilitating tracheal intubation conditions during rapid sequence induction of anesthesia, after which adequate intubation conditions are established within 60 seconds in nearly all patients. If a dose of 0.6 mg/kg body weight is used for rapid sequence induction of anesthesia, it is recommended to intubate the patient 90 seconds after administration of rocuronium bromide. In patients undergoing cesarean section, it is recommended to only use a dose of 0.6 mg/kg body weight, since a 1.0 mg/kg body weight dose has not been investigated in this patient group.

Maintenance dosing:
The recommended maintenance dose is 0.15 mg rocuronium bromide per kg body weight; in the case of long-term inhalational anesthesia this should be reduced to 0.075-0.1 mg/kg body weight.

The maintenance doses should best be given when twitch height has recovered to 25% of control twitch height, or when 2 to 3 responses to train of-four (TOF) stimulation are present.

Continuous infusion:
If rocuronium bromide is administered by continuous infusion, it is recommended to give a loading dose of 0.6 mg rocuronium bromide per kg body weight and, when neuromuscular block starts to recover, to start administration by infusion. The infusion rate should be adjusted to maintain twitch response at 10% of control twitch height or to maintain 1 to 2 responses to TOF stimulation.

In adults under intravenous anesthesia, the infusion rate required to maintain neuromuscular block at this level ranges from 0.3-0.6 mg/kg/h and under inhalational anesthesia the infusion rate ranges from 0.3-0.4 mg/kg/h. Continuous monitoring of neuromuscular block is recommended since infusion rate requirements vary from patient to patient and with the anesthetic method used.

Dosing to facilitate mechanical ventilation:
The use of initial loading dose of 0.6 mg rocuronium bromide per kg body weight is recommended, followed by a Continuous infusion as soon as twitch height recovers to 10% or upon reappearance of 1 to 2 twitches to TOF stimulation. Dosage should always be titrated to effect in the individual patient. The recommended initial infusion rate for the maintenance of a neuromuscular block of 80-90% (1 to 2 twitches to TOF stimulation) in adults patients is 0.3-0.6 mg/kg/h during the first hour of administration, which will need to be decreased during the following 6-12 hours, according to the individual response. Thereafter, individual dose requirements remain relatively constant.

Administration

The dosage of rocuronium bromide should be individualized in each patient.

Geriatric Patients

The standard intubation dose for geriatric patients and patients with hepatic and/or biliary tract disease and/or renal failure during routine anesthesia is 0.6 mg rocuronium bromide per kg body weight. A dose of 0.6 mg/kg body weight should be considered for rapid sequence induction of anesthesia in patients in which a prolonged duration of action is expected. Regardless of the anesthetic technique used, the recommended maintenance dose for these patients is 0.075-0.1 mg/kg body weight, and the recommended infusion rate is 0.3-0.4 mg/kg/hour.

Patients with Hepatic and/or Biliary Tract Disease and/or Renal Failure

The standard intubation dose for geriatric patients and patients with hepatic and/or biliary tract disease and/or renal failure during routine anesthesia is 0.6 mg rocuronium bromide per kg body weight. A dose of 0.6 mg/kg body weight should be considered for rapid sequence induction of anesthesia in patients in which a prolonged duration of action is expected. Regardless of the anesthetic technique used, the recommended maintenance dose for these patients is 0.075-0.1 mg/kg body weight, and the recommended infusion rate is 0.3-0.4 mg/kg/hour.

Overweight and Obese Patients

When used in overweight or obese patients (defined as patients with a body weight of 30% or more above ideal body weight) doses should be reduced taking into account a lean body mass.