Sedation, analgesia and paralysis
Rocuronium (Zemuron) drip
Zemuron
Dosing
| Start | 8–12 mcg/kg/min after an intubating dose |
|---|---|
| Titrate | To train-of-four 1–2 of 4 and the clinical goal |
| Maximum | Usually under 12 mcg/kg/min |
| Common bags | 500 mg in 500 mL (1 mg/mL); 500 mg in 50 mL (10 mg/mL) |
| Dose units | mcg/kg/min |
Line and administration
- Peripheral or central
Watch for
- No sedation or analgesia: give both first
- Prolonged effect in liver disease and older adults
- Reverse with sugammadex
Rocuronium: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Airway and RSIRSI drugs: Sugammadex reverses rocuronium or vecuronium; 16 mg/kg reverses rocuronium immediately. Watch for anaphylaxis, bradycardia; backup contraception for 7 days.
- Myasthenic Crisis and Guillain-Barré SyndromeNIV or intubation: MG: resists succinylcholine; deep, long block with rocuronium, so less drug, train-of-four, sugammadex
- Asthma and COPD ExacerbationsIntubating severe asthma: Rapid sequence: ketamine 1–2 mg/kg (bronchodilates, less hypotension) or propofol, with rocuronium 1–1.2 mg/kg or succinylcholine
- Mass Casualty Triage and Incident CommandCBRNE: decontamination, nerve agents and radiation: Nerve agents inhibit acetylcholinesterase. Vapor acts in seconds to minutes: miosis, rhinorrhea and chest tightness, then bronchorrhea, bronchospasm, fasciculations, seizures and apnea. Liquid on skin can take up to 18 hours to cause systemic effects (Merck 2026). In Tokyo, over 20% of St Luke's staff had symptoms of secondary exposure (Ohbu 1997
- Toxidromes and AntidotesCarbon monoxide, cyanide, methemoglobin and organophosphates: Organophosphates inhibit acetylcholinesterase, producing muscarinic, nicotinic (fasciculations, weakness, paralysis) and CNS effects. The inhibited enzyme 'ages' into a permanent form, while carbamates release it within about 48 h (Merck). Atropinize to a clear chest, HR over 80 and SBP over 80, then infuse 10–20% of the loading dose pe
Practice Airway and RSI questions free74 exam-style questions with rationales on the topic where rocuronium comes up most. No account or download needed.
Other sedation, analgesia and paralysis
- Propofol
- Dexmedetomidine
- Midazolam
- Fentanyl
- Cisatracurium
- Ketamine
- Hydromorphone
- Vecuronium
- Pentobarbital
- Remifentanil
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.