Rocuronium bromide

Dose Esvarone individually selected according to the method of general anesthesia, the expected duration of the operation, possible interactions with other drugs administered before and / or during anesthesia, and the general condition of the patient.

To assess the degree of suppression and restoration of neuromuscular reactions, it is recommended to use appropriate instrumental methods.

To facilitate tracheal intubation, Esmeron is administered at a dose of 0.6 mg / kg. The recommended maintenance dose is 0.15 mg / kg; in case of prolonged inhalation anesthesia, it should be reduced to 0.075-0.1 mg / kg. Maintenance doses are best administered at a time when the degree of muscle contraction is restored to 25% of the control level.

To relax the skeletal muscles during surgical interventions, the drug is administered by continuous infusion. In this case, it is recommended to give a loading dose of 0.6 mg / kg, and when the relaxation of the skeletal muscles begins to weaken, start the infusion. The rate of administration should be selected so that the skeletal muscle contractile response is 10% of the control level.

In adults, with intravenous general anesthesia, the infusion rate necessary to maintain muscle relaxation at this level is 5–10 mcg / kg / min, and for inhalation anesthesia, 5–6 mcg / kg / min.

It is important to constantly monitor the state of the neuromuscular system, since the required rate of infusion may be different for different patients and with different methods of anesthesia.

In patients with overweight or obesity (body weight by 30% exceeds the ideal) dose should be reduced, recalculated to lean body mass.

Application dataEsmerona pregnant women are absent, so it is impossible to assess its potential harm to the fetus. In animal studies to date, no such undesirable action of Esmeron has been found.

Esmeron should be prescribed to a pregnant woman only in the case when, according to the doctor watching her, the expected benefits of using the drug outweigh the risk. Esmerone can be used for cesarean section as a component of rapid sequential induction of anesthesia, provided that there is no risk of difficult intubation, the use of sufficient doses of anesthetics or to maintain myoplegia after intubation while using succinylcholine. At a dose of 0.6 mg / kg of body weight, Esmeron demonstrated his safety for patients given birth by cesarean section. Esmeron did not cause changes in the Apgar scale, the muscle tone of the fetus and the indices of cardio-respiratory adaptation. In the blood samples from the umbilical cord, only minor traces of rocuronium bromide were found, which do not cause the development of clinically significant side effects in the newborn.

Note: Doses of 1.0 mg / kg body weight during cesarean section have not been studied.

Recovery from neuromuscular blockade caused by muscle relaxants may be suppressed or insufficiently in patients receiving magnesium salts for pregnancy toxicosis, since magnesium salts increase neuromuscular blockade. In this regard, in such patients the dose of Esmerone should be reduced and titrated by the skeletal muscle contractile response.

Usage dataEsmerona breastfeeding women do not. Esmerone should be prescribed to a nursing mother only when, in the opinion of the attending physician, the expected benefits of using the drug outweigh the risk.

Since Esmeron causes paralysis of the respiratory muscles, it is absolutely necessary for patients receiving this drug to perform an artificial ventilation of the lungs until adequate recovery of spontaneous breathing.

Doses exceeding 0.9 mg of rocuronium bromide / kg body weight can lead to an increase in heart rate; This effect can counteract the bradycardia caused by other anesthetics or arising from stimulation of the vagus nerve.

There is not enough data to recommend Esmeron for use in intensive care units. In general, prolonged muscle relaxation, persisting after prolonged use of muscle relaxants, has been reported in patients in intensive care units. With continued neuromuscular blockade, it is important that patients receive adequate analgesia and sedatives, and that neuromuscular transmission is monitored throughout this period. Moreover, muscle relaxants should be administered in carefully selected doses sufficient to maintain incomplete blockade, and the introduction should be carried out by an experienced physician familiar with or supervised by their effects, as well as under adequate instrumental control.

Since Esmerone is always used in conjunction with other drugs, and during anesthesia, even in the absence of known provoking agents, malignant hyperthermia may develop, before any general anesthesia can begin, general practitioners should be familiar with the early manifestations, factors confirming the diagnosis and methods of treatment of malignant hyperthermia. In animal studies proved that Esmeron is not a factor provoking the development of malignant hyperthermia.

The following factors may affect the pharmacokinetics and / or pharmacodynamics of Esmerone:

Diseases of the liver and / or biliary ducts and renal failure

Since rocuronium is excreted in the urine (up to approximately 30% within 12-24 hours) and it is assumed that it can also be partially excreted with bile, Esmerone should be used with caution in patients with clinically severe liver and / or biliary tract and / or renal failure. A prolongation of the effect was observed in these groups of patients at doses of 0.6 mg / kg body weight rocuronium bromide.

Increased circulation time

Factors that lead to an increase in the time of circulation of the drug in the blood, such as cardiovascular diseases, old age and swelling, leading to an increase in the volume of distribution, may contribute to a later start of the drug's action.

Neuromuscular Diseases

Like other muscle relaxants, Esmerone should be used with extreme caution in patients with diseases of the neuromuscular system or poliomyelitis, since the reaction to muscle relaxants can be significantly changed in these cases. The magnitude and direction of these changes can be very different. In patients with severe myasthenia or myasthenic syndrome (Eaton-Lambert syndrome), small doses of Esmerone can cause a pronounced neuromuscular block, therefore, it is necessary to carry out a preliminary selection of the effective dose by the method of titration.

Hypothermia

When conducting surgical interventions against hypothermia, Esmeron’s blocking effect on the neuromuscular system is enhanced, and the duration of action is increased.

Obesity

Like other muscle relaxants, Esmeron may have a longer lasting effect, and spontaneous restoration of the normal state of neuromuscular conduction after its use may be longer in obese patients.

States that can enhance the effect of Esmeron

Hypokalemia (for example, after severe vomiting, diarrhea or diuretic treatment), hypermagneemia, hypocalcemia (after massive transfusions), hypoproteinemia, dehydration, acidosis, hypercapnia, cachexia.

In this regard, severe imbalance of electrolytes, changes in blood pH or dehydration should be, if possible, corrected.

Symptoms: an increase in the degree and duration of myorelaxation.

Treatment: IVL should be continued, and at the beginning of spontaneous recovery of respiration, an adequate dose of acetylcholinesterase inhibitor should be injected (for example, neostigmine, edrofoniya, pyridostigmine). If the administration of an acetylcholinesterase inhibitor does not relieve the blocking effect of Esmeron, ventilation should be continued until spontaneous breathing is restored. Repeated administration of an acetylcholinesterase inhibitor can be dangerous.