Rocuronium

Advantages:

• Slower onset (45-120 seconds), but longer duration (30-90 minutes)

• Ideal for maintenance of anesthesia to sustain paralysis

Mechanism: 

• Antagonizes acetylcholine receptors on the muscle cell, preventing depolarization and contraction of the muscle.

• The block is eventually terminated as endogenous acetylcholine concentration increases and displaces rocuronium from the receptor. 

Reversal:

• If rocuronium was administered in the last 2 hours, neostigmine or suggamadex is needed to reverse paralysis

Contraindications:

• Known hypersensitivity to rocuronium