Background: Rocuronium is a muscle relaxant with increased use due to its binding
relation with the reversal agent sugammadex. The purpose of this review entails the investigation of
its use for the maintenance of Deep Neuromuscular Block (NMB) via continuous infusion.
Methods: Based on PRISMA systematic search guidelines, databases included PubMed, ISI Web of
Science, Cochrane Library and Google Scholar. This comprehensive search addresses surgical patients
under deep muscle relaxation via continuous rocuronium infusion. The main indicators were
the rocuronium administration, NMB monitoring approaches and effects in order to maintain the
deep level of relaxation, as well as reversal time after a standard dose of sugammadex.
Results: Despite the variance in approaches found in the literature, findings show the overall maintenance
of deep NMB requires approximately 0.758 mg.kg-1h-1 of rocuronium (according to the
PTC target of 0-10, 0-5 and 1-2, mean estimates are 0.445, 0.65 and 0.833 mg.kg-1h-1 respectively),
suggesting that a lower range and a smaller maximum of PTC response require higher amount of
rocuronium for its maintenance. The standard dose of sugammadex (4 mg/kg), administered at the
end of the surgery takes longer [2.85 (1.17) min] than when they are administered after moderate
NMB recovery [1.68 (0.47) min].
Conclusion: Continuous infusion for deep NMB presents inherent advantages in terms of maintenance
and stability of muscle relaxation. Monitoring and rocuronium administration approaches are
fundamental and intrinsically connected to provide a stable and improved maintenance of deep