Sedation, analgesia and paralysis
Rocuronium (Zemuron) drip
Zemuron
Dosing
| Start | 8–12 mcg/kg/min after an intubating dose |
|---|---|
| Titrate | To train-of-four 1–2 of 4 and the clinical goal |
| Maximum | Usually under 12 mcg/kg/min |
| Common bags | 500 mg in 500 mL (1 mg/mL); 500 mg in 50 mL (10 mg/mL) |
| Dose units | mcg/kg/min |
Line and administration
- Peripheral or central
Watch for
- No sedation or analgesia: give both first
- Prolonged effect in liver disease and older adults
- Reverse with sugammadex
Rocuronium: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Airway and RSIRSI drugs: Sugammadex reverses rocuronium or vecuronium; 16 mg/kg reverses rocuronium immediately. Watch for anaphylaxis, bradycardia; backup contraception for 7 days.
- Asthma and COPD ExacerbationsIntubating severe asthma: Rapid sequence: ketamine 1–2 mg/kg (bronchodilates, less hypotension) or propofol, with rocuronium 1–1.2 mg/kg or succinylcholine
- Mass Casualty Triage and Incident CommandCBRNE: decontamination, nerve agents and radiation: Nerve agents inhibit acetylcholinesterase. Vapor acts in seconds to minutes: miosis, rhinorrhea and chest tightness, then bronchorrhea, bronchospasm, fasciculations, seizures and apnea. Liquid on skin can take up to 18 hours to cause systemic effects (Merck 2026). In Tokyo, over 20% of St Luke's staff had symptoms of secondary exposure (Ohbu 1997
- Paramedic Practice: Safety, Quality, Leadership and CommunicationChecks, storage and controlled drugs: Heat. Ambulance and aircraft compartments routinely exceed controlled room temperature: one 2025 UK study logged up to 46.8 °C in a helicopter, with indoor storage protecting against cold much better than against heat (Maait and Phillipson). Studies it cites found lorazepam degrading after 120 days on EMS units, atropine and naloxone degrading with heat, and 1
- Toxidromes and AntidotesCarbon monoxide, cyanide, methemoglobin and organophosphates: Organophosphates inhibit acetylcholinesterase, producing muscarinic, nicotinic (fasciculations, weakness, paralysis) and CNS effects. The inhibited enzyme 'ages' into a permanent form, while carbamates release it within about 48 h (Merck). Atropinize to a clear chest, HR over 80 and SBP over 80, then infuse 10–20% of the loading dose pe
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Other sedation, analgesia and paralysis
- Propofol
- Dexmedetomidine
- Midazolam
- Fentanyl
- Cisatracurium
- Ketamine
- Hydromorphone
- Vecuronium
- Pentobarbital
- Remifentanil
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against your local protocols and medical direction, the bag label and your pump.