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Differences in rocuronium over other non-depolarizing muscle relaxants (NDMR) include which of the following?

E. Active metabolism by liver enzymes

==Answer==

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Intubating conditions rated at 30-s intervals after rocuronium 0.6 mg/kg, vecuronium 0.1 mg/kg, or atracurium 0.5 mg/kg in children. Intubation was attempted every 30 s, beginning 30 s after drug administration, until intubation could be achieved with acceptable conditions (i.e., good or excellent). Once intubation was accomplished, no further attempts were made. A significant difference (P < 0.05) exists for rating excellent intubating conditions at the point of successful intubation in the rocuronium group compared with the vecuronium as well as the atracurium group.([http://www.ncbi.nlm.nih.gov/pubmed/8694312 Scheiber G1, Ribeiro FC, Marichal A, Bredendiek M, Renzing K. Intubating conditions and onset of action after rocuronium, vecuronium, and atracurium in young children. Anesth Analg. 1996 Aug;83(2):320-4.)]|right]]

The answer is A. Of the nondepolarizing muscle relaxants in current use, rocuronium has the most rapid onset of action at clinically indicated dosages. Rocuronium is a nondepolarizing neuromuscular relaxant with an intermediate duration of action in adults, although this duration of action may be prolonged in infants and may be classified as a long-acting NMBD.  Its duration of action in adults is similar to vecuronium, atracurium, and cisatracurium. Rocuronium may have a prolonged duration of action in patients with renal or hepatic dysfunction, especially at higher dosing (2-3 x ED95).  At an ED95 dose (0.3 mg/kg), the onset time is 1.5 to 3 minutes, whereas with the other intermediate nondepolarizing muscle relaxants, the onset time is much longer (3 to 7 minutes). Increasing the dosage of rocuronium to 2-4 x the ED95 can decrease onset time to 60-90 seconds.  This makes rocuronium a viable alternative for rapid sequence induction of patients in which you may want to avoid succinylcholine (pediatric population).  <ref>Barash: Clinical Anesthesia, ed 5, pp 427, 435-436</ref>.

==Notes==

<references />

[http://www.ncbi.nlm.nih.gov/pubmed/17479026 Meakin GH. Curr Opin Anaesthesiol. 2007 Jun;20(3):227-31.Role of muscle relaxants in pediatric anesthesia.]

[[Wikipedia:Neuromuscular-blocking_drug]]

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