Safety aspects of non-depolarizing neuromuscular blocking agents with special reference to rocuronium bromide

The safety of neuromuscular relaxants can be assessed according to their cardiovascular and autonomic effects, their liability to release histamine, their tendency to cause anaphylactic/anaphylactoid reactions, their effect on cholinesterase, on intra-ocular and intracranial pressure, their tendency to cumulation and their reversibility. Any adverse effects of metabolites are also potential problems. Against these standards, rocuronium may have some mild vagolytic activity. Apart from that, its safety profile is indistinguishable from that of vecuronium.