Rocuronium Dosage for Pediatric Intubation

Rapid Sequence Intubation Dosing

The American Academy of Pediatrics recommends rocuronium at >0.9 mg/kg when used as an alternative to succinylcholine in rapid sequence induction 1
For rapid sequence intubation in children, a dose of at least 0.9 mg/kg rocuronium is recommended to achieve comparable intubation conditions to succinylcholine 1, 2
The French guidelines recommend rocuronium at a dose >0.9 mg/kg as a good alternative to succinylcholine when succinylcholine is contraindicated 3, 4

Succinylcholine remains the first choice for rapid sequence induction in children when not contraindicated 2
Age-appropriate doses of succinylcholine are: <1 month: 1.8 mg/kg, 1 month to 1 year: 2.0 mg/kg, 1-10 years: 1.2 mg/kg, >10 years: 1.0 mg/kg 3, 5
Rocuronium should be used when succinylcholine is contraindicated, such as in cases of primary muscle damage (myopathies) or up-regulation of nicotinic acetylcholine receptors 2, 5

Neuromuscular blockade monitoring is recommended following muscle relaxant use in all pediatric patients, with an estimated 28% frequency of residual neuromuscular blockade 2
Always flush IV tubing with saline before administering rocuronium after other medications to avoid precipitation and obstruction 1
Personnel with skills in airway management must be present and prepared to respond when rocuronium is administered 1
Age-appropriate equipment for suctioning, oxygenation, intubation, and ventilation should be immediately available 1
Rocuronium does not provide sedation, analgesia, or amnesia, so appropriate sedative/analgesic agents must be administered concurrently 1