Rocuronium bromide in the ICU: dose finding and pharmacokinetics

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Pharmacology

Background:

• Neuromuscular blocking agents are essential for mechanical ventilation in intensive care units (ICUs).
• Rocuronium is commonly used for intubation and maintaining neuromuscular blockade.
• Different administration methods, such as intermittent boluses versus continuous infusions, may impact efficacy and safety.

Purpose of the Study:

• To compare the efficacy and safety of intermittent boluses versus continuous infusion of rocuronium for maintaining neuromuscular blockade in mechanically ventilated ICU patients.
• To evaluate the pharmacokinetics of rocuronium in ICU patients receiving continuous infusions.

Main Methods:

• A prospective study involving 30 patients requiring elective mechanical ventilation in the ICU.
• Patients received either intermittent boluses (n=25) or a continuous infusion (n=5) of rocuronium.
• Neuromuscular blockade was monitored using train-of-four (TOF) stimulation, aiming for one twitch.

Main Results:

• Continuous rocuronium infusion led to better control of ventilation compared to intermittent boluses.
• Patients receiving continuous infusion experienced a more intense neuromuscular block (9.9 +/- 1.3 microgram kg-1 min-1) versus the bolus group (6.4 +/- 2.3 microgram kg-1 min-1).
• Pharmacokinetic parameters (elimination half-time, volume of distribution, mean residence time) were significantly longer in ICU patients than in surgical patients, while plasma clearance remained similar.

Conclusions:

• Continuous rocuronium infusion offers improved ventilation control in ICU settings.
• The deeper neuromuscular blockade associated with continuous infusion requires careful monitoring.
• Rocuronium pharmacokinetics in critically ill patients differ from those in surgical patients, necessitating individualized dosing adjustments.