This page shows what was measured, who it was measured in, and what that does not settle.
What Rocuronium does in the body
The nerve keeps signalling and the muscle stays limp until the drug diffuses away or is chemically removed.
Nerves make muscles contract by releasing a chemical called acetylcholine onto receptors on the muscle. Rocuronium is shaped enough like acetylcholine to occupy those receptors, but not enough like it to switch them on. So it sits in the way. It is deliberately a weak drug: because a weak drug has to be given in large numbers of molecules, the concentration gradient driving it into the junction is steep, and it arrives fast.
Why people take it. Paralysing the muscles so a breathing tube can be placed and so the body stays still during an operation
What happened in people
A permanent quaternary charge that excludes the drug from the central nervous system, so it has no effect on consciousness or pain
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The recorded finding that sits closest to something a person would notice. Written into the record, not signed off, and it carries no population or interval.
NCT01865513 — POPULAR, post-anaesthesia pulmonary complications after use of muscle relaxants (NCT01865513) · a recorded source, not a stored snapshot
The limit that matters most
That neuromuscular monitoring, reversal, sugammadex or extubation at a train-of-four ratio above 0.9 reduces pulmonary complications — all four came back null in the largest prospective study of the question
Where it acts
Postsynaptic membrane of the motor endplate, at the neuromuscular junction of skeletal muscle
Kind of result
Symptoms and quality of life
Supervision
Professional supervision is normally required. A regulator classifies this substance in a way that restricts how it is supplied.
What the registries record it as
The substance registry classes this as chemical.
FDA substance registry · I65MW4OFHZ · read 2026-08-29
Where each sentence above came from
A person wrote this explanation into the record, with the studies named in the path below.
The recorded use, written for a reader without medical training. Not signed off.
A limit recorded against this substance. Not signed off as a reviewed claim.
The four opening statements run to 132 words.
Words this page uses
Four words worth knowing first
Chosen from what this page shows, with each one explained before the word it depends on.
Comparator
A comparator is whatever the treatment was measured against.
A picture of it, and where the picture fails
It is like the other runner in a race.
Where that stops being true. A race has one winner. A study can show both arms improved.
What people get wrong. Results are read without asking what the other group got. Beating nothing is not beating a treatment.
The control condition against which the experimental intervention is assessed.
Randomisation
Randomisation means chance decides who gets which treatment.
A picture of it, and where the picture fails
It is like a coin toss deciding the groups.
Where that stops being true. A coin toss is fair once. Fairness here comes from doing it for everyone.
What people get wrong. It is thought to make groups identical. It makes them similar on average, including on things nobody measured.
Allocation of participants to arms by a chance process, so that unmeasured factors are balanced in expectation.
Absolute difference
An absolute difference is how many more people in a hundred were affected.
A picture of it, and where the picture fails
It is like counting heads in two rooms of a hundred.
Where that stops being true. Heads are easy to count. Study results carry a margin of error too.
What people get wrong. It is confused with a percentage change, which can look far larger.
The arithmetic difference in event rates between arms.
Confidence interval
A confidence interval is the range the true answer is likely to sit in.
A picture of it, and where the picture fails
It is like a weather forecast giving a range rather than one number.
Where that stops being true. A forecast range covers tomorrow. This one covers what the study could resolve.
What people get wrong. The middle number is read as the answer. A range crossing zero means no change is still possible.
An interval estimate that would contain the true parameter in a stated proportion of repeated studies.
What happened in people◇Read from sources, not yet reviewed
What happened in people
Each card is one study: the exact question it asked, who was in it, and whether it showed what it set out to show.
Excellent intubating conditions during rapid sequence induction
✗ The study did not show it
Who was studied
Tran Cochrane review of rocuronium versus succinylcholine for rapid sequence intubation
How many people
4151
Study design
Systematic review and meta-analysis of 50 randomised and controlled clinical trials
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
Succinylcholine superior: risk ratio 0.86 (95% CI 0.81 to 0.92) for excellent conditions and 0.97 (95% CI 0.95 to 0.99) for clinically acceptable conditions
Repeated elsewhere
Replicated
What this does not prove. A study that did not show an effect does not show that no effect exists anywhere.
The limits of this study, and where it came from
Main limit. High incidence of detection bias and significant heterogeneity across trials limits this to moderate-quality evidence. No severe adverse outcomes were reported in any included trial, which means the trials cannot speak to the harms that motivate the choice of rocuronium in the first place.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Sterile aqueous solution for intravenous bolus and infusion, buffered near pH 4, refrigerated at 2 to 8 degrees C with a limited room-temperature in-use period
Interval reported. 95% CI 0
Written into the record, not signed off as a reviewed claim.
Incidence of postoperative pulmonary complications from end of surgery to day 28
✗ The study did not show it
Who was studied
POPULAR — post-anaesthesia pulmonary complications after use of muscle relaxants (NCT01865513)
How many people
22803
Study design
Multicentre prospective observational cohort at 211 hospitals in 28 countries
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
Relaxant use adjusted odds ratio 1.86 (95% CI 1.53 to 2.26); neuromuscular monitoring 1.31 (1.15 to 1.49); reversal agents 1.23 (1.07 to 1.41); sugammadex versus neostigmine 1.03 (0.85 to 1.25); extubation at train-of-four ratio 0.9 or above 1.03 (0.82 to 1.31)
Repeated elsewhere
Failed to Replicate
What this does not prove. A study that did not show an effect does not show that no effect exists anywhere.
The limits of this study, and where it came from
Main limit. Only 2.3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without a relaxant, so confounding by indication is severe and the headline association cannot be read as causal.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Sterile aqueous solution for intravenous bolus and infusion, buffered near pH 4, refrigerated at 2 to 8 degrees C with a limited room-temperature in-use period
Interval reported. 95% CI 1
Written into the record, not signed off as a reviewed claim.
Incidence, culprit agent distribution and clinical features of perioperative anaphylaxis
✓ The study showed what it set out to show
Who was studied
NAP6 — 6th National Audit Project on perioperative anaphylaxis
How many people
266
Study design
National prospective audit of Grade 3 to 5 reactions over one year
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
Estimated incidence about 1 in 10,000 anaesthetics; neuromuscular blocking agents were 65 of 199 identified culprits; non-depolarising agents had similar incidences to one another and succinylcholine was twofold more likely
Repeated elsewhere
Partially Replicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. Case exclusion for reporting delay and incomplete data means the true incidence might be about 70% higher. Only 24% of cases were reported to the national pharmacovigilance scheme, so routine surveillance was capturing a quarter of what a dedicated audit found.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Sterile aqueous solution for intravenous bolus and infusion, buffered near pH 4, refrigerated at 2 to 8 degrees C with a limited room-temperature in-use period
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Composite of major postoperative pulmonary complications — pneumonia, respiratory failure or other pulmonary complication
✓ The study showed what it set out to show
Who was studied
STRONGER — sugammadex versus neostigmine and postoperative pulmonary complications
How many people
45712
Study design
Multicentre matched-cohort observational analysis across 12 US hospitals
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
3.5% with sugammadex versus 4.8% with neostigmine; adjusted odds ratio 0.70 (95% CI 0.63 to 0.77), pneumonia 0.53 (0.44 to 0.62), respiratory failure 0.45 (0.37 to 0.56)
Repeated elsewhere
Failed to Replicate
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. Observational and matched on institution, sex, age, comorbidity, obesity, procedure type and relaxant, but not randomised. Its direction is opposite to POPULAR's null result on the same comparison, and neither study can settle it.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Sterile aqueous solution for intravenous bolus and infusion, buffered near pH 4, refrigerated at 2 to 8 degrees C with a limited room-temperature in-use period
Interval reported. 95% CI 0
Written into the record, not signed off as a reviewed claim.
RNAWiki holds 4 written-up human studies for this substance, each with the question it asked.
How we know it
Each card names the study, the number of people and what the study set out to measure.
What this does not prove
These summaries were written by a person and have not been signed off as reviewed claims.
Why it matters
A study that failed is as informative as one that worked, and both are here.
What we still do not know
No reviewed claim exists, so no exact population, effect size or interval is published yet.
What it changes in the body◇Read from sources, not yet reviewed
The path through the body
From what a person takes to what changes. A solid line is a step measured in people. A dashed line is a step nobody has measured that way.
Start
Rocuronium
What a person takes: Sterile aqueous solution for intravenous bolus and infusion, buffered near pH 4, refrigerated at 2 to 8 degrees C with a limited room-temperature in-use period.
The measurement behind this step
Refrigeration is a chemistry requirement, not a convention: the 3-acetate ester hydrolyses on storage to 3-desacetylrocuronium, so the room-temperature in-use period is a stability specification. The acidic formulation is why injection through a running line commonly causes pain or withdrawal in a lightly anaesthetised patient, and why it is not mixed with alkaline drugs such as thiopental in the same line. The drug is given intravenously only; there is no other route and no depot presentation.
Getting in
Injected into a vein and confined to the bloodstream
The molecule carries a permanent positive charge, so it cannot cross into the brain or into cells. It stays in the water outside cells and goes where the blood takes it.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
The fixed quaternary ammonium charge restricts distribution to the extracellular fluid and excludes the drug from the central nervous system entirely. This is why the label states rocuronium has no known effect on consciousness, pain threshold or cerebration, and why paralysis and anaesthesia are separate problems that must be separately solved.
NCT01865513 — POPULAR, post-anaesthesia pulmonary complications after use of muscle relaxants (NCT01865513) · a recorded source, not a stored snapshot
Reaching the cell
Its weakness makes it fast
Because it is a weak drug, a large number of molecules has to be given. That large number creates a steep gradient into the tiny gap between nerve and muscle, and the receptors fill quickly.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Rocuronium is roughly six to eight times less potent than vecuronium, from which it was derived by replacing a piperidine with a morpholine and a methyl with an allyl group. Bowman's relationship — onset varies inversely with potency across a neuromuscular blocker series — is the design principle: the molar dose is what drives diffusion into the junctional cleft.
NCT01865513 — POPULAR, post-anaesthesia pulmonary complications after use of muscle relaxants (NCT01865513) · a recorded source, not a stored snapshot
What it acts on
It occupies the acetylcholine site without switching it on
The receptor needs two acetylcholine molecules to open. Rocuronium sits in one of those slots and does nothing, so the channel stays shut.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
The nicotinic receptor of the adult endplate is a pentamer of two alpha1, one beta1, one delta and one epsilon subunit, with agonist sites at the alpha1-delta and alpha1-epsilon interfaces. Occupancy of a single site by a competitive antagonist prevents channel opening, and because transmission has a large safety margin, roughly 70 to 80% of receptors must be occupied before any weakness is measurable at all.
NCT01865513 — POPULAR, post-anaesthesia pulmonary complications after use of muscle relaxants (NCT01865513) · a recorded source, not a stored snapshot
The change it makes
The nerve keeps firing and the muscle stops answering
Nothing about the nerve changes. It goes on releasing its transmitter into a gap where the receiving stations are already occupied, and the muscle stays limp.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Block is competitive and surmountable, which is the basis of neostigmine reversal: inhibiting acetylcholinesterase raises junctional acetylcholine concentration so it can outcompete the antagonist. That strategy has a ceiling, because once the enzyme is fully inhibited no further acetylcholine can be recruited, and it is why neostigmine cannot reverse a profound block at all.
NCT01865513 — POPULAR, post-anaesthesia pulmonary complications after use of muscle relaxants (NCT01865513) · a recorded source, not a stored snapshot
What that does for a person
Complete, silent, reversible paralysis
Muscles relax in a sequence — small fast muscles of the eye and jaw first, the diaphragm last and least — and the patient cannot move, breathe or signal anything at all.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
The diaphragm is comparatively resistant and recovers first, while the upper airway and pharyngeal muscles are among the most sensitive and the last to recover fully, which is the physiological reason residual block is an airway and aspiration problem rather than a ventilation problem. Detecting it requires a quantitative train-of-four ratio; clinical tests such as head lift are insensitive to ratios between 0.5 and 0.9.
NCT01865513 — POPULAR, post-anaesthesia pulmonary complications after use of muscle relaxants (NCT01865513) · a recorded source, not a stored snapshot
What that does for a person
It washes out, or it is pulled out
Left alone, the drug is taken up by the liver and excreted, and power returns over three quarters of an hour or so. Given the antidote, it is trapped in the bloodstream and removed from the junction within minutes.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
Elimination is primarily biliary with a smaller renal component, and duration is prolonged in hepatic impairment. Sugammadex reverses by encapsulation rather than by competition: a one-to-one inclusion complex forms in plasma, the free plasma concentration collapses, and the gradient reverses so that drug leaves the junction. Because the mechanism is sequestration rather than competition with acetylcholine, it works at depths of block where an anticholinesterase has no effect at all.
NCT01865513 — POPULAR, post-anaesthesia pulmonary complications after use of muscle relaxants (NCT01865513) · a recorded source, not a stored snapshot
No suggested links are held for this record, so nothing is hidden from this path.
What we know
The record describes 6 steps from taking it to an effect in a person.
How we know it
Each step names the study behind it in the technical detail beside it.
What this does not prove
A change inside the body is a reason to look. It is not a result in a person.
Why it matters
A reader can see exactly where the chain stops being measured in people.
What we still do not know
No reviewed claim binds any of these steps to a named population.
What is missing or unclear◇Read from sources, not yet reviewed
Were people like you studied?
RNAWiki cannot tell whether a study fits you. It can show who was in it, and where the result stops carrying.
Who was studied
People similar to this profile were included.
Most adults having a general anaesthetic with a breathing tube, and most patients intubated in an emergency department or intensive care unit.
Who is missing from the studies
Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What the label states about particular groups
On pediatric, the label states: “The use of Rocuronium Bromide Injection has been studied in pediatric patients 3 months to 14 years of age under halothane anesthesia.”
US prescribing information · ad34ecc7-ff1f-4ee5-a235-e453873d0313 · read 2026-08-30
On older people, the label states: “Rocuronium Bromide Injection was administered to 140 geriatric patients (65 years or greater) in US clinical trials and 128 geriatric patients in European clinical trials.”
US prescribing information · ad34ecc7-ff1f-4ee5-a235-e453873d0313 · read 2026-08-30
On people who are pregnant, the label states: “Developmental toxicology studies have been performed with rocuronium bromide in pregnant, conscious, nonventilated rabbits and rats.”
US prescribing information · ad34ecc7-ff1f-4ee5-a235-e453873d0313 · read 2026-08-30
Where the result stopped carrying
The intubating-conditions case for replacing succinylcholine failed: fifty randomised trials still favour the older drug
Every proposed mitigation of residual neuromuscular block failed to show a pulmonary benefit in POPULAR — monitoring, reversal, agent choice and extubation threshold alike
Routine pharmacovigilance failed to capture perioperative anaphylaxis: only 24% of NAP6 cases had been reported through the national scheme
This is a scope explorer, not a diagnosis engine.
It shows who was studied so you can see whether people similar to you were included.
RNAWiki cannot tell whether a study fits you. It can show who was in it.
What it would be like to take◇Read from sources, not yet reviewed
Why it might seem to do nothing
A real effect and a noticed effect are different things. These are the recorded reasons the two come apart.
It was studied in different people
The people in the studies were not much like the reader.
On this record: Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
The evidence may simply be wrong
Small early studies often do not hold up.
On this record: RNAWiki has not yet published a reviewed conclusion for this use.
Other reasons RNAWiki checked and found nothing for (11)
It was studied for a different goal
The studies measured something else entirely. Nothing in this record points to this reason.
A different form was studied
The studied form is not the form on the shelf. Nothing in this record points to this reason.
There was nothing to correct
Where a level is already normal, topping it up may change nothing. Nothing in this record points to this reason.
Something else had to happen too
In the studies it was paired with training, a diet or another treatment. Nothing in this record points to this reason.
The change is too small to feel
A real change can still sit below what a person notices. Nothing in this record points to this reason.
Day-to-day swing hides it
Sleep, food, stress and time of day move most numbers more than this would. Nothing in this record points to this reason.
Not enough time yet
The studies ran longer than the person has waited. Nothing in this record points to this reason.
It was not taken as studied
Missed days change the result, and studies count them. Nothing in this record points to this reason.
Something else changed at the same time
Two changes at once cannot be told apart afterwards. Nothing in this record points to this reason.
The product may not be what it says
Contents of a sold product are not always what the label states. Nothing in this record points to this reason.
No recorded reason
RNAWiki has nothing stored that would explain it. Nothing in this record points to this reason.
None of these is a reason to take more. Taking more is not a step this page ever suggests.
What it would be like to take◇Read from sources, not yet reviewed
What taking it involves
The recorded facts about getting hold of it and using it. Nothing here is a suggestion about what you should do.
How it is supplied
Given by a clinician
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
Read from the recorded approval status.
No source is stored against this line.
Form and route
Sterile aqueous solution for intravenous bolus and infusion, buffered near pH 4, refrigerated at 2 to 8 degrees C with a limited room-temperature in-use period
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form and route recorded on this substance.
No source is stored against this line.
Who oversees it
Professional supervision is normally required. A regulator classifies this substance in a way that restricts how it is supplied.
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
Suppression classes recorded: S7.
No source is stored against this line.
What is in the pack
Refrigeration is a chemistry requirement, not a convention: the 3-acetate ester hydrolyses on storage to 3-desacetylrocuronium, so the room-temperature in-use period is a stability specification.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on how this is sold. The rest of the recorded wording: The acidic formulation is why injection through a running line commonly causes pain or withdrawal in a lightly anaesthetised patient, and why it is not mixed with alkaline drugs such as thiopental in the same line. The drug is given intravenously only; there is no other route and no depot presentation.
No source is stored against this line.
Where it is registered
Regulatory records are listed in the technical disclosure at the foot of this page.
# Counted from records
Where this came from
A count of rows RNAWiki holds. It describes our records, not your body.
Register entries are stored per jurisdiction and shown with their dates.
No source is stored against this line.
Why people stop
Not recorded.
∅ Nothing recorded
Where this came from
RNAWiki holds nothing here and says so rather than guessing.
No record of why people stopped taking it is stored for this substance.
No source is stored against this line.
What it would be like to take◇Read from sources, not yet reviewed
What can go wrong
Sorted by where each line came from. A regulator's label and a report somebody sent in are not the same kind of fact.
·Worth asking a clinician aboutWritten into the record from the studies named on this page
This drug paralyses without sedating and has no effect on consciousness or pain, so it must never be given to a patient who is not already unconscious or who cannot be ventilated. Its duration is much longer than succinylcholine's, which is the accepted trade for avoiding succinylcholine's specific harms. Neuromuscular blocking agents are the second commonest cause of perioperative anaphylaxis after antibiotics, with an overall anaphylaxis incidence of about 1 in 10,000 anaesthetics. Residual block below a train-of-four ratio of 0.9 is undetectable by clinical examination and affects pharyngeal and airway muscles preferentially. Duration is prolonged in hepatic impairment. Nothing on this page is dosing guidance.
Nobody counted how many people took this and were fine, so this cannot be turned into a rate.
NCT01865513 — POPULAR, post-anaesthesia pulmonary complications after use of muscle relaxants (NCT01865513) · a recorded source, not a stored snapshot
Over a long time. No completed tested study window is recorded, so long-term effects are not established by the registry record.
Groups the studies covered thinly. Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What is missing or unclear◇Read from sources, not yet reviewed
Does the exact form matter?
Evidence belongs to the exact thing that was tested. A different salt, a different mixture or a different preparation is a different question.
The form that was studied
Sterile aqueous solution for intravenous bolus and infusion, buffered near pH 4, refrigerated at 2 to 8 degrees C with a limited room-temperature in-use period
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form used in the studies cited on this page.
No source is stored against this line.
What is sold
A recorded note compares this form with the others that are sold. It is kept below, word for word.
§ A fixed RNAWiki sentence
Where this came from
Wording RNAWiki always uses, not a finding about this substance.
The recorded note, unchanged: The acidic formulation is why injection through a running line commonly causes pain or withdrawal in a lightly anaesthetised patient, and why it is not mixed with alkaline drugs such as thiopental in the same line. The drug is given intravenously only; there is no other route and no depot presentation.
No source is stored against this line.
What is recorded as being sold
3 published labels name it as an active ingredient. 3 of them describe this substance alone, which is where its own label text on this page comes from.
US prescribing information · 98255b70-51f9-8d16-e053-2995a90a8f97 · read 2026-08-29
Those labels are classed as human prescription drug.
US prescribing information · 98255b70-51f9-8d16-e053-2995a90a8f97 · read 2026-08-29
Rocuronium is intravenous at 3 DOSAGE FORMS AND STRENGTHS Rocuronium Bromide Injection is available as 5 mL multiple dose vials containing 50 mg rocuronium bromide injection (10 mg/mL) 5 mL multiple dose vials containing 50 mg rocuronium bromide in…, recorded as fda label in effect 2024-03-19 in the United States.
US prescribing information · ad34ecc7-ff1f-4ee5-a235-e453873d0313 · read 2026-08-30
Evidence carries across two names for one substance. It does not carry across a salt, a mirror form or a mixture.
What it would be like to take◇Read from sources, not yet reviewed
What you could measure
This one is decided with a clinician, so this section holds questions to ask rather than a plan to run.
Self-experiment planning is not offered for a prescription or clinician-supervised medicine. The questions below are for a clinician or pharmacist.
Questions worth asking
Which of the trials of Rocuronium studied people like me?
What was measured, and for how long?
Was the result a laboratory value or a health outcome?
What would we watch for, and when would we stop?
Tracking can show whether something changed for you. It cannot show what caused it.
RNAWiki records evidence. It does not say whether this substance is right for you.
What is missing or unclear◇Read from sources, not yet reviewed
Claims that go past the evidence
Things said about this substance that sound reasonable, and the exact step that is missing between the evidence and the claim.
✗Goes past the evidence
That neuromuscular monitoring, reversal, sugammadex or extubation at a train-of-four ratio above 0.9 reduces pulmonary complications — all four came back null in the largest prospective study of the question
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That reaching a train-of-four ratio of 0.9 is a patient outcome; it is a surrogate, and the study that tested it against a real outcome found no association
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the STRONGER result showing 30% fewer pulmonary complications with sugammadex is settled — the other large cohort found an odds ratio of 1.03
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the excess pulmonary complications seen with relaxant use are caused by the relaxant, when only 2.3% of high-risk patients were managed without one
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
What is missing or unclear◇Read from sources, not yet reviewed
What nobody knows yet
Open questions, each with why it is open and what would close it.
Missing populations
Which groups were under-represented in the studies has not been recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing long-term data
No completed tested study window is recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
No reviewed conclusion
RNAWiki has not yet published a reviewed conclusion for this use.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing interaction studies
No interaction was found in the registers checked. Not finding one is not the same as showing there is none.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Formulation uncertainty
Several salts, forms or products of Rocuronium are recorded. Results from one form may not transfer to another.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Mechanism not reviewed
No reviewed mechanism story exists for this substance.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
What happened in people◇Read from sources, not yet reviewed
Check any of this yourself
Every line above traced back to the study it came from. This is the technical layer, and the vocabulary changes here.
Every line above can be traced to the study named beside it. Follow the link and read it.
Fifty randomised trials say the 1952 drug still intubates better
In plain words
Rocuronium was introduced partly to replace an older paralysing agent with dangerous side effects. Pooling every randomised comparison — 4,151 patients — the older drug still produced better conditions for placing the breathing tube.
What was measured
Risk ratio for excellent and for clinically acceptable intubating conditions across 50 randomised trials
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
Tran and colleagues updated their Cochrane review through February 2015, including any randomised or controlled clinical trial reporting intubating conditions with rocuronium at 0.6 mg/kg or more against succinylcholine at 1 mg/kg or more, in any age group or setting. Fifty trials with 4,151 participants were summarised. Succinylcholine was superior for excellent intubating conditions, risk ratio 0.86 (95% CI 0.81 to 0.92, n=4,151), and for clinically acceptable conditions, risk ratio 0.97 (95% CI 0.95 to 0.99, n=3,992, 48 trials). The advantage was larger when thiopental was the induction agent, risk ratio 0.81 (95% CI 0.73 to 0.88, n=2,302, 28 trials). At the highest rocuronium dose studied there was no statistical difference in intubating conditions, and the reviewers still judged succinylcholine clinically superior because of its much shorter duration of action. No severe adverse outcomes were reported in any included trial. High detection bias and significant heterogeneity limit this to moderate-quality evidence, and the conclusion was unchanged from the previous update. The reason rocuronium is nevertheless used for rapid sequence intubation is that succinylcholine's harms — hyperkalaemic arrest, malignant hyperthermia, prolonged block — are catastrophic when they occur, which is a legitimate argument the intubating-conditions data does not measure.
Written into the record, not signed off as a reviewed claim
POPULAR: using a relaxant at all tracked with more lung complications, and nothing fixed it
In plain words
Twenty-two thousand patients across Europe were followed after surgery. Those given a paralysing agent had almost twice the odds of a pulmonary complication — and using a nerve monitor, giving a reversal drug, choosing the newer reversal drug, or waiting for full recovery before removing the tube made no measurable difference.
What was measured
Adjusted odds ratio for postoperative pulmonary complications to day 28, by relaxant use, monitoring, reversal agent and train-of-four ratio at extubation
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
Kirmeier and colleagues prospectively recruited adults having general anaesthesia for any in-hospital procedure except cardiac surgery, at 211 hospitals in 28 European countries, over two weeks, with a postoperative physical examination within three days and follow-up to day 28. Data from 22,803 patients were collected. Use of a neuromuscular blocking agent was associated with an increased incidence of postoperative pulmonary complications — 1,658 of 21,694 patients, 7.6% — with an adjusted odds ratio of 1.86 (95% CI 1.53 to 2.26). The four mitigations widely believed to solve the problem all came back null: neuromuscular monitoring, adjusted odds ratio 1.31 (95% CI 1.15 to 1.49); administration of reversal agents, 1.23 (1.07 to 1.41); sugammadex rather than neostigmine, 1.03 (95% CI 0.85 to 1.25); and extubation at a train-of-four ratio of 0.9 or above, 1.03 (95% CI 0.82 to 1.31). None was associated with better pulmonary outcomes. This is an observational study and confounding by indication is severe — only 2.3% of high-risk patients were anaesthetised without a relaxant, so the comparison groups are not alike. It is on this page because it is the largest prospective attempt to demonstrate the benefit of monitoring and reversal, and it did not.
Written into the record, not signed off as a reviewed claim
Neuromuscular blockers are the second commonest cause of anaesthetic anaphylaxis
In plain words
A year-long national audit of every serious allergic reaction under anaesthesia in the United Kingdom found paralysing agents responsible for 65 of the 199 reactions where a culprit was identified — second only to antibiotics.
What was measured
Distribution of culprit agents across 199 identified cases, and estimated incidence of perioperative anaphylaxis
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
The 6th National Audit Project collected and reviewed 266 reports of Grade 3 to 5 perioperative anaphylaxis over one year from all NHS hospitals in the United Kingdom. Estimated incidence was about 1 in 10,000 anaesthetics, and the authors note that exclusions for reporting delay and incomplete data mean the true figure might be around 70% higher. Of 199 identified culprit agents, antibiotics accounted for 94, neuromuscular blocking agents 65, chlorhexidine 18 and Patent Blue dye 9. Within the relaxants, succinylcholine-induced anaphylaxis — mainly presenting with bronchospasm — was twice as likely as with the other agents, and the non-depolarising agents, rocuronium among them, had similar incidences to one another. Onset was rapid for relaxants and antibiotics. Hypotension was the commonest presenting feature at 46% and every patient was hypotensive at some point. There were 40 cardiac arrests and 10 deaths, with pulseless electrical activity the usual arrest rhythm. Only 24% of cases were reported to the national pharmacovigilance scheme.
Written into the record, not signed off as a reviewed claim
Made weak on purpose: low potency is what buys the fast onset
In plain words
Rocuronium is a deliberately weakened version of an older drug. Because you have to give many more molecules to get the same effect, the drug floods into the gap between nerve and muscle faster, and paralysis arrives sooner.
What was measured
Relative potency against vecuronium and the resulting onset time, with the fixed quaternary charge confining distribution to the extracellular space
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Rocuronium was derived from vecuronium by two substitutions that reduce receptor affinity: a morpholine replacing the piperidine at the 2-beta position, and an allyl rather than methyl quaternising group at C16. The result is roughly six to eight times lower potency and correspondingly faster onset, consistent with Bowman's relationship that within a series of neuromuscular blockers onset time varies inversely with potency. The mechanism is diffusion: for a given clinical effect, a low-potency drug is administered at a far higher molar dose, so the concentration gradient from plasma into the synaptic cleft is steeper and receptor occupancy builds faster. This is an unusual entry for this file because it is a design decision made against the usual direction of drug development — potency was traded away deliberately — and because the property it bought is the entire clinical case for the molecule.
Source
FDA-approved US prescribing information for rocuronium bromide injection, Clinical Pharmacology; and the structure-activity relationship established across the aminosteroid neuromuscular blocking series
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
verified
Review state
Written into the record, not signed off as a reviewed claim
Paralysis removes every clinical sign that anaesthesia is inadequate
In plain words
Without a relaxant, a patient who is not deeply enough anaesthetised moves, grimaces or breathes against the ventilator. A paralysed patient does none of those things, so the warning system is gone and the anaesthetist is reasoning from indirect signs.
What was measured
That monitoring practices developed for unparalysed patients remain adequate once the motor signs of light anaesthesia have been abolished pharmacologically
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
The clinical signs conventionally used to judge anaesthetic depth — purposeful movement, facial grimacing, respiratory effort against the ventilator — are all motor outputs, and a neuromuscular blocking agent abolishes all of them without touching consciousness. Rocuronium's permanent quaternary charge means it does not cross the blood-brain barrier at all, so it has no hypnotic, amnestic or analgesic effect whatsoever. What remains available to the anaesthetist are autonomic signs, which are unreliable and confounded by every other drug given, and processed electroencephalographic monitors, which are indirect. This entry is filed as inferred rather than measured because the quantity of interest — how much of the awareness risk in paralysed patients is attributable to the loss of motor signs rather than to the underlying anaesthetic technique — has not been isolated by any trial. What is not in doubt is the pharmacology: this drug paralyses without sedating, and every case of awareness with paralysis is a case where those two effects came apart.
Source
FDA-approved US prescribing information for rocuronium bromide injection, Warnings — rocuronium has no known effect on consciousness, pain threshold or cerebration
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
caution
Review state
Written into the record, not signed off as a reviewed claim
Sugammadex made a long-acting relaxant behave like a short one — on a surrogate
In plain words
Rocuronium's drawback against the older drug was that its effect lasts much longer. An antidote that grabs the molecule out of the bloodstream was supposed to erase that drawback, and it does erase it on the nerve monitor. Whether it changes what happens to patients is disputed by the two largest studies.
What was measured
That reversing rocuronium with sugammadex reduces postoperative pulmonary complications — supported by one large matched cohort, contradicted by another large prospective cohort, and never tested against a clinical outcome in a randomised trial
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Sugammadex is a modified gamma-cyclodextrin that forms a one-to-one inclusion complex with rocuronium in plasma, creating a concentration gradient that draws the relaxant off the neuromuscular junction. On the surrogate endpoint — time to a train-of-four ratio of 0.9 — the effect is large, fast and reproducible, including from depths of block that neostigmine cannot reverse at all. On patient outcomes the evidence conflicts. STRONGER, a matched-cohort analysis of 45,712 patients across 12 United States hospitals, found sugammadex associated with a 30% lower adjusted odds of major pulmonary complications (adjusted odds ratio 0.70, 95% CI 0.63 to 0.77), 47% lower for pneumonia and 55% lower for respiratory failure. POPULAR, a prospective observational cohort of 22,803 patients across 28 European countries, found no association at all between the choice of sugammadex over neostigmine and pulmonary outcomes (adjusted odds ratio 1.03, 95% CI 0.85 to 1.25). Both are observational, both are large, and they disagree. The correct summary is that a surrogate improvement is certain and an outcome improvement is contested.
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What is not here
8 questions this page could not answer
These sections were prepared and left out because there was nothing to put in them. They are listed rather than hidden, so the gaps in this record are visible.
What was measured, goal by goal — found nothing in the sources checked.
How close this is to real life — found nothing in the sources checked.
Felt, measured, or meaningful — found nothing in the sources checked.
How long anything takes — found nothing in the sources checked.
What it may clash with — found nothing in the sources checked.
Other ways to the same goal — found nothing in the sources checked.
How this medicine reached us — found nothing in the sources checked.
What changed on this page — found nothing in the sources checked.
The record as stored
The full record, for auditing
Everything above is built from what is below. This layer keeps the technical vocabulary, record identifiers and every stored row, so a reader who wants to check the page can.
The older medicine-wide conclusion held in this record
Written for a clinical reader, and about the medicine as a whole rather than about one indication, population and set of trials. RNAWiki does not treat it as a programme conclusion and no reviewer has signed it off in that form. It is here word for word because it is what the record holds.
A steroid-backbone competitive blocker of the neuromuscular junction, deliberately made weak so that more molecules can be given and onset is fast — and, across 50 randomised trials and 4,151 participants, measurably worse than the 1952 drug it was meant to replace at producing excellent intubating conditions, with a risk ratio of 0.86.
Recorded evidence blocks (9)
Q2
On the Rocuronium label: indicated for what?
"Rocuronium Bromide Injection is indicated as an adjunct to general anesthesia to facilitate both rapid sequence and routine tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation. Rocuronium Bromide Injection is a nondepolarizing neuromuscular blocking agent indicated…": indications and usage on Rocuronium's label. DailyMed label · 04c9812d-5aa3-4949-ad02-c618028f1bb0 · 2026-08-02
Q3
194 registered trials of Rocuronium — at which phases?
Registered studies posting no result
143 of 194
194 registered studies of Rocuronium: 74 phase4, 67 na, 23 phase3, 13 na or unstated, 13 phase2, 4 early phase1, 1 phase1. CLINICALTRIALS_SNAPSHOT · 2026-09-01
1069 with a PubMed record
Show the evidence
phase4
74
na
67
phase3
23
na or unstated
13
phase2
13
early phase1
4
8 more recorded rows
phase1
1
completed
142
unknown
34
not yet recruiting
5
recruiting
4
terminated
4
withdrawn
4
active not recruiting
1
recorded 2026-09-01 · last checked 2026-09-04
Q4
7 of Rocuronium's trials stopped: futility/efficacy, accrual/recruitment, other?
1 to 2 minutes; The rapid distribution half-life is 1 to 2 minutes and the slower distribution half-life is 14 to 18 minutes.
metabolismpharmacokinetics
Studies of distribution, metabolism, and excretion in cats and dogs indicate that rocuronium is eliminated primarily by the liver.
recorded 2026-08-02 · last checked 2026-09-04
Q7
Which 84 trials of Rocuronium posted no result?
Posted no result
84 of 84 completed trials
Registrations
NCT00988520, NCT00984633, NCT00970762, NCT02785653, NCT00124722 and NCT00540085, and 78 more
Completion dates
oldest 2003-09; newest 2024-08-29
Show the evidence
Trial
NCT00988520
2003-09
NCT00984633
2003-12
NCT00970762
2004-02
NCT02785653
2006-11
NCT00124722
2007-07
NCT00540085
2008-02
14 further recorded trials
NCT01124383
2010-02
NCT01142635
2010-03
NCT01035021
2010-04
NCT00902070
2010-10
NCT01030510
2010-10
NCT00953550
2011-02
NCT01532466
2011-11
NCT01902641
2012-03
NCT01479751
2012-08
NCT01591031
2013-02
NCT01824758
2013-05
NCT01651572
2013-07
NCT02486926
2014-01
NCT01851005
2014-02
Q8
At the median, Rocuronium's trials enrolled 84.5 people — anything larger?
Median enrolment
84.5
Largest enrolment
30430
Registered trials counted
194
Q9
What do 2702 spontaneous reports say about Rocuronium — and not say?
These are reports people sent to a regulator. They do not show the medicine caused the reaction. Nobody counted how many people took the medicine and reported nothing. The same event can be reported more than once, and many reports are incomplete. News coverage, lawsuits and new warnings change how often people report. A count is not a rate and not a risk.
Rocuronium appears in spontaneous reports to regulators. Across the 10 most-reported reaction terms, 2702 reaction mentions were counted: anaphylactic reaction 653; anaphylactic shock 527; hypotension 401; cardiac arrest 231. FAERS via Open Targets · CHEMBL1200648 · 2026-06-24
Show the evidence
anaphylactic reaction
653
anaphylactic shock
527
hypotension
401
cardiac arrest
231
tachycardia
202
bronchospasm
169
4 more recorded rows
urticaria
143
bradycardia
130
neuromuscular block prolonged
125
oxygen saturation decreased
121
recorded 2026-06-24 · last checked 2026-09-04
Q10
Which 10 reactions does Rocuronium's label not list?
ChEMBL 37 — CC BY-SA 3.0 Unported · ChEMBL ATC CC BY-SA · ClinicalTrials.gov — US Government work · Open Targets 26.06 — CC0 · mixed register set; per-register licences in docs/specs/corpus-20k-sources.md · openFDA / DailyMed — US Government work
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✓ public claims reviewed: 0 reviewed claim(s); drafts are never rendered
✓ source coverage passed: 6 source rows
✓ no critical contamination: no quarantine open
✓ canonical metadata passed: slug and display name present
✓ no raw internal fields: enforced by the copy-contract test over the rendered page
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