Rocuronium Bromide: A Comprehensive Pharmacological and Clinical Monograph

1.0 Executive Summary

Rocuronium is an aminosteroid, nondepolarizing neuromuscular blocking agent (NMBA) distinguished in modern anesthetic practice by its characteristically rapid onset of action and intermediate duration.[1] As a cornerstone of anesthesia, it is employed as an adjunct to general anesthesia to facilitate both routine and rapid sequence tracheal intubation (RSI), as well as to provide profound skeletal muscle relaxation during surgical procedures and for patients requiring mechanical ventilation.[3] Its primary clinical advantage lies in its ability to achieve intubating conditions at a speed comparable to the depolarizing agent succinylcholine, particularly when administered at higher doses, but with a more favorable and safer side-effect profile, establishing it as a critical alternative for RSI.[5]

A transformative development in the clinical use of rocuronium has been the introduction of sugammadex, a selective relaxant binding agent (SRBA). While the neuromuscular blockade induced by rocuronium can be partially reversed by traditional acetylcholinesterase inhibitors like neostigmine, sugammadex offers a unique mechanism that allows for rapid, complete, and reliable reversal of even deep levels of blockade.[1] This innovation has profoundly enhanced the safety profile and clinical utility of rocuronium, allowing for more aggressive dosing with a reliable safety net.[7]