How to Use Rocuronium for Tracheal Intubation

Abstract

 Rocuronium, a desacetoxy derivate of vecuronium, shares the intermediate duration of action with vecuronium. However, the onset of action of rocuronium is considerably faster than vecuronium. Recommended dose for endotracheal intubation is 0.6 mg/kg (2 X ED₉₅) , which completely inhibits muscle twitches in about 90 seconds. However, higher doses should be used for rapid sequence intubation. Following 1 mg/kg of rocuronium, good to excellent conditions for endotracheal intubation are obtained within 60 seconds. Overall, intubating conditions with high-dose rocuronium are similar when compared with those of suxamethonium. Priming principle is clinically used more to shorten the onset of rocuronium. However, the optimal priming and intubating doses of rocuronium have not been clearly elucidated, and even a small priming dose causes rocuronium injection pain when used in awake patients. Timing principle using high-dose rocuronium is also a useful method for rapid sequence intubation. For laryngeal mask insertion, very low-dose (0.1-0.3 mg/kg) rocuronium is effective. It is important for anesthesiologists to know how to adjust the dose of rocuronium and to know how to administer rocuronium upon considering patient's conditions and varieties of anesthesia.