Systematic Review on Rocuronium Continuous Infusion for Deep Neuromuscular Blockade

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Rocuronium is a widely used muscle relaxant, increasingly utilized with sugammadex for reversal.
• Deep neuromuscular block (NMB) maintenance is crucial in surgical settings.

Purpose of the Study:

• To review the use of continuous rocuronium infusion for maintaining deep NMB.
• To analyze rocuronium administration, NMB monitoring, and sugammadex reversal characteristics.

Main Methods:

• Systematic literature search following PRISMA guidelines across major databases.
• Inclusion of studies on surgical patients receiving continuous rocuronium infusion for deep NMB.
• Analysis of rocuronium dosage, NMB monitoring, and sugammadex reversal times.

Main Results:

• Maintenance of deep NMB typically requires around 0.758 mg/kg/h of rocuronium, with dosage varying by train-of-pulse (PTC) target.
• Lower PTC targets necessitate higher rocuronium infusion rates.
• Sugammadex reversal at 4 mg/kg is significantly longer after deep NMB (2.85 min) compared to moderate NMB recovery (1.68 min).

Conclusions:

• Continuous rocuronium infusion offers advantages for stable deep NMB maintenance.
• Effective deep NMB management relies on precise monitoring and administration strategies.
• Understanding these factors is key for optimizing anesthetic care and reversal.