When it comes to the timing of rocuronium administration, it is critical to consider the characteristics of the patient as well as the clinical setting. For example, if the patient does not have a significant risk of regurgitation, it may be appropriate to administer a lower dose of rocuronium at induction and then adjust the dose posteriorly.
Sugammadex is administered as an intravenous bolus, and is administered in doses of 2.0, 4.0, 8.0, 12.0, or 16.0 mg/kg. It should be administered within 10 seconds of an existing intravenous line.
Sugammadex has no metabolites, and its elimination is via renal excretion. It is excreted in urine at a rate of 88 mL/hr and has a half-life of 2 hours. In one study, 90% of the dose of sugammadex was excreted in urine, with less than 0.2% of the drug excreted in feces.
However, sugammadex is contraindicated in patients with a history of anaphylaxis. Patients with anaphylaxis should be monitored carefully for any allergic reactions. The incidence of anaphylactic reactions was 2.0% in the placebo group, 2% in the four-mg/kg group, and 9% in the 16-mg/kg group. Sugammadex is not recommended in pediatric patients, as the manufacturer has not approved it for this use.
The duration of NMB is closely related to the dose required to achieve complete neuromuscular blockade. A repeat dose and an increasing dosage may be necessary to achieve the desired effects. For a repeat dose, a higher dose of rocuronium is required to achieve the desired level of neuromuscular relaxation.
Sugammadex reverses the effects of rocuronium-induced neuromuscular blockade in pediatric and adult patients. It is more effective than neostigmine in reversing this effect. The recovery time was 1.6 minutes after rocuronium administration.
It is not possible to predict how long after sugammadex can you safely give rocuronium, but there are a few guidelines to follow. The patient must be ventilated and the medicinal product should not be administered again while the patient is under observation. The administration of the medicinal product should be stopped if it causes displacement. During this time, the patient should be monitored for 15 minutes.
If the patient receives two doses of rocuronium in one session, it is recommended that the second one be administered at least ten minutes after the second. However, it is possible that the second dose could prolong the action of the third dose.
Sugammadex, as well as other neuromuscular blockers, may cause the patient to have delayed renal recovery. To avoid this, it is recommended to give a second dose of rocuronium at least twelve hours after sugammadex.