Rocuronium effect

 Q: Remifentanil ___________________ the onset of paralysis of Rocuronium. (select one)

A) expedites

B) delays

Answer: B 

Succinylcholine and Rocuronium are the two most commonly used paralytics in ICU for rapid sequence intubation (RSI). Rocuronium is a nondepolarizing neuromuscular blocking agent (NMBA). 

Rocuronium's time to intubation-level paralysis is about 45-60 seconds. Remifentanil delays this onset further by 30 to 45 seconds. On the other hand, a flush of little higher dose of Normal Saline (NS) i.e., 20 mL after Rocuronium IV push decreases the time to onset as well as prolongs its effect. Magnesium infusion prolongs the time of its paralysis. 

Rocuronium dose should be calculated with ideal body weight of the patient. The usual dose is 1 to 1.2 mg/kg IV bolus.

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References:

1. Ishigaki S, Masui K, Kazama T. Saline Flush After Rocuronium Bolus Reduces Onset Time and Prolongs Duration of Effect: A Randomized Clinical Trial. Anesth Analg 2016; 122:706. 

2. April MD, Arana A, Pallin DJ, et al. Emergency Department Intubation Success With Succinylcholine Versus Rocuronium: A National Emergency Airway Registry Study. Ann Emerg Med 2018; 72:645. 

3. Na HS, Hwang JW, Park SH, et al. Drug-administration sequence of target-controlled propofol and remifentanil influences the onset of rocuronium. A double-blind, randomized trial. Acta Anaesthesiol Scand 2012; 56:558. 

4. Hans GA, Bosenge B, Bonhomme VL, et al. Intravenous magnesium re-establishes neuromuscular block after spontaneous recovery from an intubating dose of rocuronium: a randomised controlled trial. Eur J Anaesthesiol 2012; 29:95.