Rocuronium Cisatracurium

Up to 30-min time to recovery with an intermediate-acting neuromuscular blocker (i.e., atracurium, cisatracurium, rocuronium, and vecuronium)... 

NMBAs are further differentiated by their duration of action during anesthesia. Succinylcholine and mivacurium are common ultra-short-acting competitive NMBAs (5-10 min). An intermediate duration of action (30-45 min) is maintained with the use of atracurium, cisatracurium, rocuronium and vecuronium. A long-lasting duration of action (90-100 min) is observed with d-tubocurarine, doxacurium, metocurine, pancuronium and pipecuronium. 

Agent Tubocuranine Pancuronium Vecuronium Atracurium Rocuronium Cisatracurium Mivacurium Cis-trans isomer Trans-trans isomer C/s-c/s isomer... 

Rocuronium Similar to cisatracurium Like cisatracurium but slight antimuscarinic effect Like cisatracurium useful in patients with renal impairment Hepatic metabolism duration, 20-35 min Toxicities Like cisatracurium... 

Kopman AF, Kopman DJ, Ng J, Zank LM. Antagonism of profound cisatracurium and rocuronium block the role of objective assessment of neuromuscular function. J ClinAnesth. 2005 17 30-35. 

Both desflurane and sevoflurane significantly increase the neuromuscular blocking effects of rocuronium compared with isoflurane or propofol (41,42). The effective doses of rocuronium for 50% depression of single twitch height were 95,120,130, and 150 pg/kg for desflurane, sevoflurane, isoflurane, and propofol respectively. There were no differences in recovery profiles between the four drugs using equieffective doses. Desflurane, sevoflurane, and to a lesser extent isoflurane, also potentiated the neuromuscular blocking effect of cisatracurium by 30% compared with propofol (43,44). 

Clinically important, potentially hazardous interactions with cisatracurium, erythromycin, kaolin, mivacurium, rocuronium, saquinavir... 

C. Known hypersensitivity or anaphylactic reaction (non-dose-related) to agent or presenrative (eg, benzyl alcohol). Succinylcholine is most commonly implicated, but anaphylaxis has been reported with rocuronium, atracurium, mi-vacurium, and cisatracurium. 

Kim KS, Chun YS, Choi SU, Suh IK. Neuromuscular intemction between cisatracurium and mivacurium, atracurium, vecurcnium or rocuronium administered in combination. Anaesthesia (1998) 53, 872-8. 

Naguib M, Samarkandi AH, Ammar A, Elfaqih SR, Al-Zahrani S, Turkistani A. Comparative clinical pharmacology of rocuronium, cisatracurium, and their combination. Anesthesiology (1998) 89,1116-24. 

Breslin DS, Jiao K, Habib AS, Schultz J, Gan TJ. Pharmacoi Tiamic interactions between cisatracurium and rocuronium.(2004) 98,107-10. 

Nondepolarizing muscle relaxants are highly dependent on renal elimination if not inactivated otherwise. Degradation pathways of the relaxants atracurium or cisatracurium bypass renal function, making them preferable in renal insufficiency. Rocuronium has an increased elimination half-life in renal failure, but its action is swiftly and reliably terminated by i.v. administration of sugamma-dex. 

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