Anesthetics:
Indications for: ZEMURON
Adjunct to general anesthesia to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Adult Dosage:
See full labeling. Individualize. Tracheal intubation: initially 0.45–0.6mg/kg; or may give bolus dose of 0.9–1.2mg/kg. All given under opioid/nitrous oxide/oxygen anesthesia. Rapid sequence intubation (premedicate and anesthetize adequately): 0.6–1.2mg/kg. Maintenance dose: 0.1mg, 0.15mg, or 0.2mg/kg given at 25% recovery of T1 (3 twitches in train-of-four). Continuous infusion: initiate at rate of 10–12micrograms/kg/min only after spontaneous recovery from intubating dose; may need additional bolus doses to maintain adequate block. Monitor with a peripheral nerve stimulator for drug response, dose adjustments, evaluate recovery and to avoid overdosage.
Children Dosage:
See full labeling. Individualize. Initial intubation or sevoflurane induction: 0.45–0.6mg/kg. Halothane induction: 0.6mg/kg. General anesthesia: sevoflurane induction and isoflurane/nitrous oxide (maintenance): bolus dose of 0.15mg/kg; halothane (maintenance): (3months to adolescence): 0.075–0.125mg/kg upon return of T1 to 0.25% to provide relaxation for 7 to 10 minutes; Or, continuous infusion: initiate at rate of 12micrograms/kg/min upon return of T1 to 10% (1 twitch in train-of-four). Monitor with a peripheral nerve stimulator for twitch response.
ZEMURON Warnings/Precautions:
To be administered under the supervision of experienced clinicians. Have intubation, artificial respiration, oxygen therapy and reversal agents available. Risk of medication errors; confirm proper selection of intended product and ensure dose is clearly labeled/communicated. Must be accompanied by adequate anesthesia or sedation. To prevent residual paralysis, should extubate only after neuromuscular block recovery. Long-term use in I.C.U. Immobilized for long periods. Malignant hyperthermia; confirm and treat prior to starting anesthesia. Cardiovascular disease or advanced age (possible delay in onset time). Neuromuscular disease, carcinomatosis, cachetic, or debilitated patients; reduce initial dose. Cerebral palsy (resistance may occur). Severe acid-base and/or electrolyte abnormalities. Pulmonary hypertension or valvular heart disease. Myasthenia gravis or myasthenic (Eaton-Lambert) syndrome (do test dose and monitor). Renal or significant hepatic impairment. Discontinue if extravasation occurs; restart in another vein. Elderly (increased risk of residual neuromuscular block). Children (rapid sequence intubation: not recommended). Labor & delivery (rapid sequence intubation in Cesarean section: not recommended). Pregnancy (Cat.C).
ZEMURON Classification:
Neuromuscular blocker (nondepolarizing).
ZEMURON Interactions:
Potentiated by inhalation anesthetics (eg, enflurane, isoflurane, halothane), antibiotics (eg, aminoglycosides, vancomycin, tetracyclines, bacitracin, polymyxins, colistin, sodium colistimethate), lithium, magnesium salts, local anesthetics, procainamide, quinidine (caution). Antagonized by anticonvulsants (eg, carbamazepine, phenytoin). Prolonged QTc interval with general anesthetics in children. Caution with other nondepolarizing muscle relaxants or succinylcholine (give rocuronium only after succinylcholine recovery). Myopathy with concomitant corticosteroids.
Adverse Reactions:
Transient hypotension, hypertension, arrhythmia, abnormal ECG, tachycardia, nausea, vomiting, asthma, hiccup, rash, inj site edema, pruritus; anaphylaxis, residual paralysis, myopathy, increased pulmonary vascular resistance.
How Supplied:
Multi-dose vials (5mL)—10
