Esmeron

• General Anesthesia Adjunct: Used to facilitate endotracheal intubation during the induction of general anesthesia.
• Skeletal Muscle Relaxation: Employed to provide skeletal muscle relaxation during surgery or mechanical ventilation.
• Facilitation of Tracheal Intubation: For rapid sequence induction (RSI) in emergency airway management.
• Mechanical Ventilation: Used in intensive care settings to facilitate mechanical ventilation by inducing muscle relaxation.
• Off-Label Uses: Occasionally used in electroconvulsive therapy (ECT) to prevent muscle contractions.

• Adults:
• Induction dose for intubation: 0.6 mg/kg IV bolus over 5 seconds.
• Rapid sequence induction: 1.0 mg/kg IV bolus.
• Maintenance dose: 0.1 to 0.2 mg/kg IV as needed.
• Pediatrics:
• Dosage similar to adults on a mg/kg basis.
• Induction: 0.6 mg/kg IV.
• Maintenance: 0.1–0.3 mg/kg IV.
• Elderly:
• Dose adjustment may be required due to reduced clearance; typically lower doses or extended dosing intervals.
• Renal/Hepatic Impairment:
• Use caution; clearance may be reduced; monitor neuromuscular blockade duration closely.
• Administration Route: Intravenous injection or infusion.
• Frequency: Single bolus for intubation; repeat doses or continuous infusion for maintenance as per clinical judgment.
• Duration: Duration depends on dose and patient factors; usually onset within 1–2 minutes, duration 20–35 minutes.

Rocuronium Bromide is a non-depolarizing neuromuscular blocking agent that competitively binds to nicotinic acetylcholine receptors at the neuromuscular junction. By blocking acetylcholine from binding, it prevents depolarization of the motor endplate, leading to muscle relaxation and paralysis. This action facilitates endotracheal intubation and provides skeletal muscle relaxation during surgery or mechanical ventilation.

• Absorption: Not applicable; administered intravenously.
• Distribution: Rapidly distributed with a volume of distribution approximately 0.2–0.3 L/kg.
• Metabolism: Minimally metabolized by the liver.
• Active Metabolites: None of clinical significance.
• Elimination: Primarily biliary excretion; about 30–40% renal excretion.
• Half-Life: Approximately 60 to 90 minutes in healthy adults.
• Onset of Action: 1 to 2 minutes post-IV administration.
• Duration of Action: Typically 20 to 35 minutes after intubating dose.

• Pregnancy: Classified as FDA Pregnancy Category C. Use only if clearly needed; limited human data available.
• Lactation: Unknown if excreted in human milk. Use caution when administered to breastfeeding mothers; benefits should outweigh risks.

• Primary Therapeutic Class: Neuromuscular blocking agent.
• Subclass: Non-depolarizing skeletal muscle relaxant.

• Known hypersensitivity to rocuronium or any component of the formulation.
• Use caution or avoid in patients with known hypersensitivity to other neuromuscular blocking agents.
• Severe hepatic impairment may warrant avoidance due to reduced clearance.
• Use caution in patients with neuromuscular diseases (e.g., myasthenia gravis).

• Monitor for signs of prolonged neuromuscular blockade and respiratory depression.
• Use with caution in patients with hepatic or renal impairment due to altered drug clearance.
• Potential for anaphylaxis or severe hypersensitivity reactions; emergency equipment must be available.
• Avoid use in patients with known sensitivity to bromide salts.
• Careful monitoring of neuromuscular function is recommended during administration.
• Risk of histamine release is low but can cause hypotension or bronchospasm in sensitive patients.

• Common:
• Injection site pain.
• Hypotension or hypertension.
• Bradycardia or tachycardia.
• Transient skin flushing.
• Serious/Rare:
• Anaphylaxis or severe allergic reactions.
• Prolonged muscle paralysis or respiratory depression.
• Bronchospasm.
• Elevated liver enzymes in rare cases.
• Side effects typically occur during or shortly after administration.

• Aminoglycosides and Tetracyclines: May potentiate neuromuscular blockade.
• Local Anesthetics: May enhance blockade effects.
• Volatile Anesthetics (e.g., Sevoflurane): Can potentiate neuromuscular blocking effects.
• Magnesium Sulfate: May enhance blockade.
• Anticholinesterase Agents: Used to reverse blockade.
• No significant CYP450 involvement.

• Recent guidelines emphasize careful dosing and neuromuscular monitoring to avoid prolonged paralysis.
• Recommendations for cautious use in patients with hepatic or renal impairment have been highlighted.
• No major changes in approved indications or dosing protocols have been reported recently.
• Updated anesthesia protocols recommend rocuronium as an alternative to succinylcholine in rapid sequence induction when succinylcholine is contraindicated.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from freezing.
• Keep container tightly closed.
• Store in original packaging to protect from light.
• No reconstitution required; supplied as a solution ready for IV use.