Rocuronium Bromide Main Life Special Precautions

Caution: Only for use by clinicians with full knowledge of the actions and usage of this drug.
Precautions related to Dosage and Administration: As the duration of action becomes longer with increased dosage, caution should be exercised when administrating 0.9 mg/kg for intubation.
In the case of continuous infusion, use a muscle relaxation monitoring device and adjust the infusion speed appropriately.
Precautions on Use: Careful administration (Administer with care to the following patients): Patients with dyspnea and airway obstruction [Ventilation failure may delay the patient's recovery of spontaneous breathing.]; Patients with liver disease, biliary disease or kidney disease [Due to delayed excretion of the drug, the duration of action may be prolonged.]; Patients with bronchial asthma [May cause asthma attack or bronchospasm.]; Patients with electrolyte abnormalities (hypokalemia, hypocalcemia, hypermagnesemia etc.), hypoproteinemia, dehydration, acidosis, hypercapnia patients [Action may be potentiated.]; Patients who use cardiopulmonary bypass by hypothermic anesthesia and hypothermic perfusion [Action may be potentiated, and duration of action may be prolonged.]; Patients with myasthenia gravis and myasthenic syndrome [These patients are extremely sensitive to non-depolarizing muscle relaxants.] (see Important Precautions as follows); Patients with neuromuscular disease except those with myasthenia gravis and myasthenic syndrome (muscular dystrophy, myotonic syndrome, congenital myopathy, spinal muscular atrophy, Guillain-Barre syndrome etc.) or patients after polio disease [May potentiate or reduce the magnitude of action]; Patients with reduced cardiac output [The onset of action may be delayed, or duration of action may be prolonged.]; Obese patients [If dose is calculated by actual weight, the duration of action may be prolonged and recovery may be delayed.]; Burn patients [It is known that the action of muscle relaxants are suppressed.]; Elderly [The duration of action may be prolonged due to delay in excretion.] (see Administration to elderly under Dosage & Administration); Patients who are or may be pregnant (see Use in Pregnancy & Lactation); Neonates, infants, toddlers or children (see Administration to paediatrics under Dosage & Administration).
Important Precautions: Because this drug causes respiratory depression, breathing should be regulated (use gas anesthetic machine or respirator) until adequate spontaneous breathing is restored.
Patients with myasthenia gravis and myasthenic syndrome are highly sensitive to non-depolarising muscle relaxants, and the muscle relaxation action is likely to be potentiated or prolonged. Always use a muscle relaxation monitor, pay careful attention to the patient's respiratory condition etc., and use sugammadex sodium as necessary to recover from muscle relaxation state. In these patients do not use anticholinesterase agents to recover from muscle relaxation.
In patients other than myasthenia gravis and myasthenic syndrome, sugammadex sodium or an anticholinesterase agent and atropine sulfate hydrate (to prevent the side effects of the anticholinesterase agent) can be administered by intravenous infusion for recovery from the muscle relaxation state induced by this drug. When administering an anticholinesterase agent, administer after confirming recovery by way of the muscle relaxation monitor or confirming spontaneous breathing. Confirm the usage, dosage, and precautions described in the package insert of each drug.
After induction of anesthesia, if suxamethonium chloride hydrate is administered for the purpose of tracheal intubation prior to administration of this drug, administer this drug after confirming that the effect of suxamethonium chloride hydrate has diminished (patient's spontaneous breathing has recovered).
In order to objectively evaluate the degree of muscle relaxation, and to use this drug safely and appropriately, use a muscle relaxation monitor as required.
Exercise caution in patients who have experienced anaphylactic reactions with suxamethonium chloride hydrate in the past, as anaphylactic reactions may also occur with this drug.
In order to prevent complications such as respiratory depression and aspiration due to the residual muscle relaxation action, extubate only after confirming that the patient's muscle relaxation has fully recovered.
If it is necessary to re-administer this drug after administration of sugammadex sodium, there is a possibility that a delay of onset of action of this drug may be observed. Therefore, exercise caution while administering this drug while sufficiently observing the patient's condition.
Precautions on applications: As sediments will form when mixed with amphotericin B, hydrocortisone succinate sodium, methylprednisolone sodium succinate, thiamylal sodium, thiopental sodium, or furosemide, either use different administration routes or, when using the same infusion line, flush the inside with a neutral solution such as saline and ensure not to mix with this drug.
Other precautions: There have been reports of prolonged muscle relaxation or quadriplegia etc. when using a different rocuronium bromide preparation continuously over long-term for an un-approved indication of respiratory control. There are also reports of other non-depolarizing muscle relaxants used in a similar manner in neonates and infants, causing deafness.