ESMERON (rocuronium bromide)

Esmeron Information

Esmeron is a fast onset, intermediate acting non-depolarizing neuromuscular blocking agent, possessing all of the characteristic pharmacological actions of this class of medicine (curariform). It is indicated : -in general anaesthesia to facilitate tracheal intubation during routine induction, and during rapid sequence induction when suxamethonium is contraindicated -To provide skeletal muscle relaxation during surgery -As an adjunct in the intensive care unit (ICU) to facilitate intubation and mechanical ventilation.

Esmeron Warnings

Since Esmeron causes paralysis of the respiratory muscles, ventilatory support is mandatory for patients treated with this agent until adequate spontaneous respiration is restored. As with all neuromuscular blocking agents, it is important to anticipate intubation difficulties, particularly when used as part of a rapid sequence induction technique. Anaphylactic reactions can occur following the administration of neuromuscular blocking agents. Precautions for treating such reactions should always be taken. Particularly in the case of previous anaphylactic reactions to neuromuscular blocking agents, special precautions should be taken since allergic cross-reactivity to neuromuscular blocking agents has been reported. Because Esmeron is always used with other agents and because the occurrence of malignant hyperthermia during anaesthesia is possible, even in the absence of known triggering agents, clinicians should be familiar with early signs, confirmatory diagnosis and treatment of malignant hyperthermia prior to the start of any anaesthesia.

In animal studies ESMERON was shown not to be a triggering factor for malignant hyperthermia. In surgery under hypothermic conditions, the neuromuscular blocking effect of ESMERON is increased and the duration prolonged. Esmeron may exhibit a prolonged duration and a prolonged spontaneous recovery in obese patients, when the administered doses are calculated on actual body weight. Patients with burns are known to develop resistance to non-depolarizing neuromuscular blocking agents. It is recommended that the dose is titrated to response. There are no data on the use of Esmeron during human pregnancy to assess potential harm to the foetus. In patients undergoing Caesarean section, ESMERON can be used as part of a rapid sequence induction technique, provided no intubation difficulties are anticipated and a sufficient dose of anaesthetic agent is administered or following succinylcholine facilitated intubation.

Drug Interactions : The following agents have been shown to influence the magnitude and/or duration of action of non-depolarizing neuromuscular blocking agents.

Esmeron Side Effects

Although very rare, severe anaphylactic reactions to neuromuscular blocking agents, including Esmeron, have been reported. These reactions have, in some cases, been fatal. Since neuromuscular blocking agents are known to be capable of inducing histamine release both locally and systemically, the possible occurrence of itching and erythematous reactions at the site of injection and/or generalized histaminoid (anaphylactoid) reactions such as bronchospasm and cardiovascular changes e.g. hypotension and tachycardia, should always be taken into consideration when administering these agents. During rapid sequence induction of anaesthesia, pain on injection has been reported, especially when the patient has not yet completely lost consciousness and particularly when propofol is used as the induction agent.

Esmeron Overdose

In the event of overdosage and prolonged neuromuscular block, the patient should continue to receive ventilatory support and sedation. Upon start of spontaneous recovery an acetylcholinesterase inhibitor (e.g. neostigmine, edrophonium, pyridostigmine) should be administered in adequate doses. When administration of an acetylcholinesterase inhibiting agent fails to reverse the neuromuscular effects of Esmeron.

Esmeron Usage Guidelines

The dosage of Esmeron should be individualized in each patient. The method of anaesthesia and the expected duration of surgery, the method of sedation and the expected duration of mechanical ventilation, the possible interaction with other medicines that are administered concomitantly and the condition of the patient should be taken into account when determining the dose. The use of an appropriate neuromuscular monitoring technique is recommended for the evaluation of neuromuscular block and recovery. Esmeron is administered intravenously either as a bolus injection or as a continuous infusion. Dose levels greater than 0.9mg Esmeron per kg body weight may increase the heart rate; this effect could counteract the bradycardia produced by other anaesthetic agents or by vagal stimulation. Esmeron can be injected into the intravenous line of a running infusion with solutions of various intravenous agents Since Esmeron does not contain a preservative, the solution should be used immediately after opening the ampoule or vial. Store Esmeron between 2-8°C in the dark. It can be stored at 8° to 30°C for 12 weeks at any time prior to the expiry date

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