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Rocuronium Continuous Infusion for Profound Neuromuscular Blockade

A Systematic Review and Meta-analysis

Couto, Mafalda MEng*,†; Nunes, Catarina PhD; Vide, Sérgio MD§; Amorim, Pedro MD§; Mendes, Joaquim PhD*,†

doi: 10.1097/WNF.0000000000000366
Review Article

Objectives Rocuronium is a muscle relaxant with increased use, because of the binding relation with the reversal agent sugammadex. Its continuous infusion benefits the maintenance of deeper levels of neuromuscular blockade (NMB) ensuring an improved and stable solution for daily surgical anesthesia. This is systematic review on current approaches on rocuronium infusion and monitoring parameters when using rocuronium continuous infusion for profound muscle relaxation (0–2 posttetanic count).

Methods Database search included publications worldwide until February 28, 2019. Main outcomes studied were the amount of rocuronium used, surgical conditions, and time of recovery after standard sugammadex dose. Secondary assessments include methodological features of rocuronium administration and blockade monitoring. Meta-analysis was conducted to assess the effect means difference of surgical conditions, followed by heterogeneity and sensitive analysis.

Results Eight randomized trials were identified as eligible. Three studies allowed to account that maintenance of profound muscle relaxation a mean difference of 0.251 mg/kg per hour (95% confidence interval = 0.169–0.334) of rocuronium is required, in relation to moderate NMB, significantly improving surgical conditions (mean difference = 0.653, 95% confidence interval = 0.451–0.856, in a 5-point scale, including data from 6 trials). Only 2 studies presented results on reversal after sugammadex; therefore, no significant results were yielded regarding the time required to complete NMB recovery.

Conclusions Rocuronium continuous infusion for profound neuromuscular blockade presents inherent advantages in terms of maintenance and stability of the paralysis. Further studies should address the methodological approaches and benefits/drawbacks of this approach.

Registration number: CRD42018106626

*FEUP – Faculdade de Engenharia da Universidade do Porto

INEGI-LAETA, Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial

Universidade Aberta, Department of Sciences and Technology, Delegation of Porto

§Centro de Investigação Clinica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal.

Address correspondence and reprint requests to Mafalda Couto, PhD student at Faculdade de Engenharia da Universidade do Porto, Rua Dr. Roberto Frias, s/n 4200-465 Porto, Portugal; E-mail:

Conflicts of Interest and Source of Funding: The study was supported by Project INEGI/LAETA – UID/EMS/50022/2013 and PhD program from FCT-MIT Portugal: LTI-EDAM (PD/BD/114378/2016). The authors have no conflicts of interest to declare.

Ethics statement: This study did not require ethics approval.

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