Rokuroniya bromide

When ATH:
M03AC09

Characteristic.

Non-depolarizing muscle relaxant with a short (closer to the center) duration of action. Monochetvertichny synthetic steroid analog of vecuronium. Coefficient n-octanol / water is 0,5 at 20 °C. Molecular weight 609,70.

Pharmacological action.
N-holinolitičeskoe, miorelaksiruyuschee, nedepoliarizuth.

Application.

Short-term muscle relaxation (for endotracheal intubation and mechanical ventilation).

Contraindications.

Hypersensitivity.

Restrictions apply.

Violation of acid-base or electrolyte balance, burns, kaxeksija, cardiovascular diseases, abnormal liver function, neuromuscular diseases (incl. myasthenia), pulmonary hypertension, renal failure, Age to 3 Months (not enough clinical experience).

Pregnancy and breast-feeding.

When pregnancy is possible, if the effect of the use outweighs the potential risk to the fetus (adequate and well-controlled studies have been conducted). It penetrates through the placenta. In studies in rats revealed no teratogenic effect dose 0,3 mg / kg.

Category actions result in FDA - C. (The study of reproduction in animals has revealed adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not held, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk.)

Unknown, Do rocuronium penetrates into breast milk.

Side effects.

Cardio-vascular system: arrhythmia, incl. tachycardia, reduction or increase in blood pressure.

From the digestive tract: nausea, vomiting, Ikotech.

Allergic reactions: angioedema, skin rash, bronchospasm, breathlessness.

Other: local reactions - swelling and pain at the injection site during extravasation.

Cooperation.

Pharmaceutical incompatible with amphotericin, amoksiцillinom, azathioprine, tsefazolynom, deksametazonom, diazepamom, Erythromycin, famotidinom, furosemidom, gidrokortizonom, insulinom, methylprednisolone, prednisolone, trimethoprim, vancomycin. Effect increase aminoglycosides, Polymyxin, tetracikliny, vancomycin, bacitracin, metronidazol (high dose), Diuretic, Alpha-blockers, beta-blockers, MAO inhibitors, protamine sulfate, magnesium salts, glitches- and mineralocorticoid, quinidine, Other non-depolarizing muscle relaxants. Atropyn, hyoscyamine - enhance the vagolytic effect. Loosen effect: aminofillin, theophylline, Phenylephrine, phenytoin, thiamine.

Means for inhalation anesthesia (enfluran, izofluran) enhance and prolong the effect (it is recommended to reduce the rate of infusion 40%).

Overdose.

Symptoms: excessive reduction of blood pressure, collapse, the weakness of the skeletal muscles, apnea, shock.

Treatment: IVL, after the appearance of signs of spontaneous recovery - neostigmine bromide, pyridostigmine bromide, simptomaticheskaya therapy.

Dosing and Administration.

B /. The rate of administration and dosage are selected and calculated individually. For intubation, adult: the initial dose - 0,6 mg / kg, supporting - 0,1; 0,15 or 0,2 mg / kg, respectively, by 12, 17 or 24 min, subject to the beginning of the restoration of conductivity 25% from baseline. When the earliest signs of muscle activity after the initial dose can be applied as a continuous infusion with an initial velocity 0,01-0,012 mg / kg / min.

Babies: the initial dose - 0,6 mg / kg, maintenance dose 0,075-0,125 mg / kg prolongs the effect for 7-10 minutes. Infusion: 0,012 mg / kg / min after the recovery of spontaneous conduction to 10% from baseline.

Additional doses should not be administered until credible evidence of the beginning of the recovery of neuromuscular conduction. The infusion rate is set individually, supervised monitoring of neuromuscular conduction using peripheral nerve stimulation.

With simultaneous use of enflurane or isoflurane infusion rate should be reduced by 40%. Patients who are overweight or obese dose is calculated on the actual weight.

Precautions.

It should be administered only anesthesiologist or technician, with experience in the use of muscle relaxants. Apply only under endotracheal anesthesia and with the conditions, required for ventilation. No effect on consciousness or pain threshold, neobhodimы adekvatnaya analgesia and sedation.

It causes intense burning pain when injected into a peripheral vein, therefore introduced only after the shutdown of consciousness.

During the monitoring of clinical effect with peripheral nerve stimulation should be considered, that the relaxation of the muscles of the larynx is faster, but less pronounced, relaxation than m. aductum thumb, and the diaphragm is more resistant to the effects of rocuronium. A more reliable criterion of the possibility of intubation is the relaxation of the vocal cords and the diaphragm compared with the severity of the neuromuscular block, recorded by a peripheral nerve stimulator with m. aductum thumb.

May slow the onset of effect in patients with cardiovascular disease or older due to the slowdown of blood circulation; large doses to accelerate the development effect is not used because of the possibility of prolonging the action.

Enhance the effect of rocuronium promote hypokalemia (for example, after severe vomiting, diarrhea, diuretic therapy), gipermagniemiya, hypocalcemia (for example, after massive blood transfusion), hypoproteinemia, degidratatsiya, Acidosis, giperkapniя, kaxeksija.

Before the appointment should be, possibly, adjusted severe electrolyte disturbances, changes in blood pH, degidratatsiya.

Doses, exceeding 0,9 mg / kg body weight, may lead to an increase in heart rate, that can counteract the bradycardia, caused by other anesthetics or arising in vagus nerve stimulation. In experimental studies have shown, that rocuronium is a factor, provokes the development of malignant hyperthermia. It must be borne in mind, during general anesthesia, even in the absence of known triggering agents, possible development of malignant hyperthermia, so experts have to closely monitor the early manifestations, confirming the diagnosis of malignant hyperthermia. In experimental studies have shown, that rocuronium is a factor, provokes the development of malignant hyperthermia.

Because the drug causes paralysis of the respiratory muscles, the ventilator should be carried out until adequate recovery of spontaneous breathing.