▶Esmeron(Merck Sharp & Dohme Ltd)
Rocuronium bromide 10 mg per 1 mlEsmeron 50 mg/ 5 ml solution
for injection vials| 10 vialP£ 28. 92 (Hospital only)
Esmeron 100 mg/ 10 ml solution for injection vials| 10 vialP
£ 57. 85 (Hospital only)eiiiiF 813Vecuronium bromide
lINDICATIONS AND DOSE
Neuromuscular blockade (intermediate duration) during
surgery
▶INITIALLY BY INTRAVENOUS INJECTION
▶Neonate:Initially 80 micrograms/kg, then (by
intravenous injection) 30 – 50 micrograms/kg, adjusted
according to response.▶Child:Initially 80 – 100 micrograms/kg, then (by
intravenous injection) 20 – 30 micrograms/kg, repeated
if necessary, alternatively (by intravenous infusion)
0. 8 – 1. 4 micrograms/kg/minute, adjusted according to
response
Assisted ventilation in intensive care
▶INITIALLY BY INTRAVENOUS INJECTION
▶Neonate:Initially 80 micrograms/kg, then (by
intravenous injection) 30 – 50 micrograms/kg, adjusted
according to response, alternatively (by intravenous
injection) initially 80 micrograms/kg, then (by
intravenous infusion) 0. 8 – 1. 4 micrograms/kg/minute,
adjusted according to response, risk of accumulation—
consider interruption of infusion.▶Child:Initially 80 – 100 micrograms/kg, initial dose is
optional, then (by intravenous infusion)
0. 8 – 1. 4 micrograms/kg/minute, adjusted according to
response, (by intravenous infusion) increased if
necessary up to 3 micrograms/kg/minute
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal bodyweight.lUNLICENSED USENot licensed for assisted ventilation in
intensive care.
lINTERACTIONS→Appendix 1 : neuromuscular blocking
drugs, non-depolarising
lSIDE-EFFECTS
▶Rare or very rareAngioedema.face oedema.
hypersensitivity.paralysis.rash erythematous
lHEPATIC IMPAIRMENTUse with caution in significant
impairment.
lRENAL IMPAIRMENTUse with caution.
lDIRECTIONS FOR ADMINISTRATIONReconstitute each vial
with 5 mL Water for Injections to give 2 mg/mL solution;
alternativelyreconstitute with up to 10 mL Glucose 5 %or
Sodium Chloride 0. 9 %orWater for Injections—unsuitable
for further dilution if not reconstituted with Water for
Injections. Forcontinuous intravenous infusion, dilute
reconstituted solution to a concentration up to
40 micrograms/mL with Glucose 5 % or Sodium Chloride
0. 9 %; reconstituted solution can also be given via drip
tubing.
Neonatal intensive care, reconstitute each vial with 5 mL
Water for Injections to give a 2 mg/mL solution. Dilute
5 mg/kg body-weight to afinal volume of 50 mL with
Glucose 5 % or Sodium Chloride 0. 9 %; an intravenous
infusion rate of 0. 5 mL/hour provides a dose of
50 micrograms/kg/hour; minimum concentration of
40 micrograms/mL.lMEDICINAL FORMS
No licensed medicines listed.1.2 Neuromuscular blockade
reversal
Neuromuscular blockade reversal
Neuromuscular blockade reversal
Anticholinesterases
Anticholinesterases reverse the effects of the non-
depolarising (competitive) neuromuscular blocking drugs
such as pancuronium bromide but they prolong the action of
the depolarising neuromuscular blocking drug
suxamethonium chloride.
Neostigmine is used specifically for reversal of non-
depolarising (competitive) blockade. It acts within one
minute of intravenous injection and its effects last for 20 to
30 minutes; a second dose may then be necessary.
Glycopyrronium bromide p. 811 or alternatively atropine
sulfate, given before or with neostigmine, prevent
bradycardia, excessive salivation, and other muscarinic
effects of neostigmine.
Other drugs for reversal of neuromuscular blockade
Sugammadex p. 817 is a modified gamma cyclodextrin that
can be used in children for the routine reversal of
neuromuscular blockade induced by rocuronium bromide.ANTICHOLINESTERASES
Neostigmine with glycopyrronium
bromide
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, neostigmine p. 648 , glycopyrronium
bromide p. 811.lINDICATIONS AND DOSE
Reversal of non-depolarising neuromuscular blockade
▶BY INTRAVENOUS INJECTION
▶Child: 0. 02 mL/kilogram, repeated if necessary,
alternatively dilute to 1 in 10 solution and give
0. 2 mL/kg; maximum 2 mL per courselINTERACTIONS→Appendix 1 : glycopyrronium.
neostigmine
lDIRECTIONS FOR ADMINISTRATIONForintravenous
injection,may be diluted with Sodium Chloride 0. 9 %, give
over 10 – 30 secondslMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Neostigmine with glycopyrronium bromide (Non-proprietary)
Glycopyrronium bromide 500 microgram per 1 ml, Neostigmine
metilsulfate 2.5 mg per 1 mlNeostigmine 2. 5 mg/ 1 ml /
Glycopyrronium bromide 500 micrograms/ 1 ml solution for injection
ampoules| 10 ampouleP£ 11. 50816 Anaesthesia adjuvants BNFC 2018 – 2019
Anaesthesia15