Definition and research guide
This page combines a MeSH definition, publication statistics and selected research abstracts. It is a starting point for reading the literature, not a medical textbook or a systematic evidence review.
Content available: 4 complete abstracts (806 words), 10 references. Full article text is not stored or reproduced here; follow the PMID, DOI or PMC links to read the original sources and their access terms.
Definition
An androstanol non-depolarizing neuromuscular blocking agent. It has a mono-quaternary structure and is a weaker nicotinic antagonist than pancuronium.
Definition: NLM Medical Subject Headings (MeSH) scope note (Public domain (U.S. National Library of Medicine); attribution requested). View the MeSH record.
Also known as: Androstane-3,17-diol, 2-(4-morpholinyl)-16-(1-(2-propen-1-yl)-1-pyrrolidiniumyl)-, 17-acetate, (2beta,3alpha,5alpha,16beta,17beta)-; 1-(17-(Acetoyl)-3-hydroxy-2-(4-morpholinyl)androstan-16-yl)-1-(2-propenyl)pyrrolidinium; ORG-9426; ORG9426; ORG 9426; Rocuronium Bromide; Pyrrolidinium, 1-((2beta,3alpha,5alpha,16beta,17beta)-17-(acetyloxy)-3-hydroxy-2-(4-morpholinyl)androstan-16-yl)-1-(2-propenyl)-, bromide; Zemuron.
Where it fits in the MeSH classification
- Broader topics
- Androstanols
Related concepts
- Pancuronium
Research landscape
PubMed indexes 2,377 records tagged with the MeSH heading “Rocuronium” (counts retrieved 2026-10-31). 542 of them (22.8%) were published from 2020 onward, and the busiest period so far is 2010-2019 with 918 records.
Reviews account for 170 records (7.2%) and meta-analyses for 32. Randomized controlled trials number 698 (29.4%) as a share of all records on the topic. Randomized trials make up a comparatively large share of this literature, which means many treatment questions have been tested directly.
Show the data
| Period | Records |
|---|---|
| through 1999 | 329 |
| 2000-2009 | 588 |
| 2010-2019 | 918 |
| 2020 onward | 542 |
Publication-type chart data
| Type | Records | Share |
|---|---|---|
| Reviews | 170 | 7.2% |
| Meta-analyses | 32 | 1.3% |
| Randomized controlled trials | 698 | 29.4% |
Method: PubMed query "Rocuronium"[MeSH Terms] with publication-type and date filters, retrieved 2026-10-31.
Reading the evidence in drugs and chemicals
Studies of a chemical or drug can answer very different questions: what it is and how it behaves in cells and animals, how the body handles it, and whether it changes outcomes in people. Laboratory and animal findings often do not carry over to patients, and observational studies of exposures are confounded by who uses a substance and why. Nothing on this page is a recommendation to use, avoid, start or stop any substance or medicine; talk to a qualified clinician or pharmacist about your own situation. Check the dose, the species, the comparison group and whether a patient-relevant outcome was measured.
Evidence from open-access studies
These open-access studies come from PubMed’s best-match results for this heading (papers whose main topic it is), ranked here by citation count, with one recent addition. Each abstract is reproduced in full under its recorded open licence so that you can read the authors’ own words. They illustrate the literature; they are not a systematic summary of it. Citation counts measure attention, not reliability or clinical benefit.
| Study / authors | Year | Source label / design | Europe PMC citations | Licence / source |
|---|---|---|---|---|
| MRGPRX2 and Adverse Drug Reactions | 2021 | Review article Design not recorded in structured metadata | 85 | cc by PMID 34421893 · DOI · PMC8377365 |
| MRGPRX2 Activation by Rocuronium: Insights from Studies with Human Skin Mast Cells and Missense Variants | 2021 | Research article Design not recorded in structured metadata | 34 | cc by PMID 33467419 · DOI · PMC7830812 |
| Use of sugammadex in patients with neuromuscular disorders: a systematic review of case reports | 2019 | Systematic review Design not recorded in structured metadata | 30 | cc by PMID 31744470 · DOI · PMC6862738 |
| Serial Fetal Heart Rate Monitoring During Electroconvulsive Therapy in Late Pregnancy: A Case Report of Transition From Succinylcholine to Rocuronium Reversed With Neostigmine | 2026 | Research article Design not recorded in structured metadata | 0 | cc by PMID 42687377 · DOI · PMC13539057 |
MRGPRX2 and Adverse Drug Reactions [1]
Abstract reading summary — source excerpts
- Opening excerpt
- Many adverse reactions to therapeutic drugs appear to be allergic in nature, and are thought to be triggered by patient-specific Immunoglobulin E (IgE) antibodies that recognize the drug molecules and form complexes with them that activate mast cells.
- Closing excerpt
- For some of these drugs, then, MRGPRX2 activation may be considered a regular and predictable feature after administration of high doses.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (166 words)
Many adverse reactions to therapeutic drugs appear to be allergic in nature, and are thought to be triggered by patient-specific Immunoglobulin E (IgE) antibodies that recognize the drug molecules and form complexes with them that activate mast cells. However, in recent years another mechanism has been proposed, in which some drugs closely associated with allergic-type events can bypass the antibody-mediated pathway and trigger mast cell degranulation directly by activating a mast cell-specific receptor called Mas-related G protein-coupled receptor X2 (MRGPRX2). This would result in symptoms similar to IgE-mediated events, but would not require immune priming. This review will cover the frequency, severity, and dose-responsiveness of allergic-type events for several drugs shown to have MRGPRX2 agonist activity. Surprisingly, the analysis shows that mild-to-moderate events are far more common than currently appreciated. A comparison with plasma drug levels suggests that MRGPRX2 mediates many of these mild-to-moderate events. For some of these drugs, then, MRGPRX2 activation may be considered a regular and predictable feature after administration of high doses.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 34421893 · DOI · PMC8377365
MRGPRX2 Activation by Rocuronium: Insights from Studies with Human Skin Mast Cells and Missense Variants [2]
Abstract reading summary — source excerpts
- Opening excerpt
- Perioperative hypersensitivity (POH) to the neuromuscular blocking drug (NMBD) rocuronium was previously thought to be IgE and mast cell (MC)-mediated.
- Closing excerpt
- Furthermore, the important differences between MrgprB2 and MRGPRX2 and the inability of rocuronium to induce enhanced response in cells expressing MRGPRX2 variants suggest that the mechanism of its POH is more complex than previously thought.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (200 words)
Perioperative hypersensitivity (POH) to the neuromuscular blocking drug (NMBD) rocuronium was previously thought to be IgE and mast cell (MC)-mediated. However, the recent seminal observation that rocuronium induces degranulation in murine peritoneal MCs (PMCs) via Mas-related G protein-coupled receptor B2 (MrgprB2) led to the idea that POH to this drug involves the activation of MRGPRX2 (human ortholog of MrgprB2). Furthermore, based on the demonstration that a patient with POH to rocuronium displayed three missense mutations (M196I, L226P and L237P) in MRGPRX2's transmembrane domains, it was proposed that this hypersensitivity reaction resulted from aberrant activation of this receptor. We found that rocuronium at 20 µg/mL caused degranulation in mouse PMCs via MrgprB2 but required at least 500 µg/mL to induce degranulation in human MCs via MRGPRX2. Furthermore, RBL-2H3 cells transiently expressing M196I, L226P and L237P variants did not display enhanced degranulation in response to rocuronium when compared to the wild-type receptor. These findings provide the first demonstration that rocuronium induces degranulation in human MCs via MRGPRX2. Furthermore, the important differences between MrgprB2 and MRGPRX2 and the inability of rocuronium to induce enhanced response in cells expressing MRGPRX2 variants suggest that the mechanism of its POH is more complex than previously thought.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 33467419 · DOI · PMC7830812
Use of sugammadex in patients with neuromuscular disorders: a systematic review of case reports [3]
Abstract reading summary — source excerpts
- Opening excerpt
- BackgroundSugammadex is a modified gamma-cyclodextrin that acts by selectively encapsulating free amino-steroidal neuromuscular relaxants.
- Closing excerpt
- Quantitative neuromuscular monitoring to ensure complete reversal and adequate postoperative monitoring is strongly recommended in these patients, despite the use of sugammadex.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (200 words)
BackgroundSugammadex is a modified gamma-cyclodextrin that acts by selectively encapsulating free amino-steroidal neuromuscular relaxants. Several case reports have been published on the use of sugammadex in patients with neuromuscular disorders that include neuromuscular junction diseases, myopathies, neuropathies, and motor neurone disorders. The primary aim of this review is to systematically review the evidence on the use of sugammadex in patients with this heterogeneous group of diseases and provide recommendations for clinical practice.MethodsA systematic electronic search of Medline, Embase and CINAHL databases was done until June 2019, to identify case reports describing the use of sugammadex in adult surgical patients with neuromuscular disorders.ResultsOf the 578 records identified through database searches, 43 articles were finally included for the systematic review. Of these, 17 reports were on patients with myopathy, 15 reports on myasthenia gravis, 9 reports on motor neuron diseases and 2 reports on neuropathies.ConclusionsMajority of the articles reviewed report successful use of sugammadex to reverse steroidal muscle relaxants, especially rocuronium, in patients with neuromuscular diseases. However, with sugammadex, unpredictability in response and uncertainty regarding optimum dose still remain issues. Quantitative neuromuscular monitoring to ensure complete reversal and adequate postoperative monitoring is strongly recommended in these patients, despite the use of sugammadex.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 31744470 · DOI · PMC6862738
Serial Fetal Heart Rate Monitoring During Electroconvulsive Therapy in Late Pregnancy: A Case Report of Transition From Succinylcholine to Rocuronium Reversed With Neostigmine [4]
Abstract reading summary — source excerpts
- Opening excerpt
- Electroconvulsive therapy (ECT) is considered relatively safe and effective for severe psychiatric disorders during pregnancy, but evidence regarding neuromuscular blockers for ECT in pregnancy remains limited.
- Closing excerpt
- This case suggests the feasibility of rocuronium with neostigmine reversal as an alternative to succinylcholine for ECT during late pregnancy when succinylcholine is unavailable, provided that multidisciplinary management and fetal monitoring are available.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (240 words)
Electroconvulsive therapy (ECT) is considered relatively safe and effective for severe psychiatric disorders during pregnancy, but evidence regarding neuromuscular blockers for ECT in pregnancy remains limited. We report a 30-year-old primigravida admitted at 30 weeks of gestation with severe major depressive disorder and persistent suicidal ideation despite pharmacotherapy. ECT was initiated at 32 weeks and 2 days of gestation. The first five sessions used succinylcholine. Owing to a nationwide shortage in Japan, the muscle relaxant was switched to rocuronium from the sixth session, with neostigmine and atropine used for reversal during the two antepartum rocuronium sessions. Serial cardiotocographic monitoring before and after each of the seven antepartum ECT sessions showed a transient decrease in fetal heart rate variability after ECT in all sessions and a transient increase in fetal heart rate baseline in five of the seven sessions (Sessions 1, 2, 3, 5, and 7), while fetal well-being was maintained throughout. Spontaneous vaginal delivery occurred at 37 weeks and 0 days, five days after the seventh ECT session. The infant developed respiratory failure shortly after birth and required ventilatory support for two days, but subsequently recovered without complications. Postpartum ECT was resumed for five additional sessions using rocuronium reversed with sugammadex, and the patient achieved clinical remission. This case suggests the feasibility of rocuronium with neostigmine reversal as an alternative to succinylcholine for ECT during late pregnancy when succinylcholine is unavailable, provided that multidisciplinary management and fetal monitoring are available.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 42687377 · DOI · PMC13539057
Key reviews and meta-analyses
The most cited review-type papers among PubMed’s best-match results for this heading, listed with bibliographic details only. Follow the links for the full text and access terms.
- Research article Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review [5]
- Research article Sugammadex Administration in Pregnant Women and in Women of Reproductive Potential: A Narrative Review [6]
- Research article Failure of reversion of neuromuscular block with sugammadex in patient with myasthenia gravis: case report and brief review of literature [7]
- Research article Rocuronium Continuous Infusion for Profound Neuromuscular Blockade: A Systematic Review and Meta-analysis [8]
- Research article The effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia: A systematic review and meta-analysis [9]
- Research article The efficacy of Antipyretic Analgesics administration intravenously for Preventing Rocuronium-Associated Pain/Withdrawal Response: a systematic review and meta-analysis [10]
References
- McNeil BD. MRGPRX2 and Adverse Drug Reactions. . 2021. PMID 34421893 · DOI · PMC8377365
- Chompunud Na Ayudhya C, Amponnawarat A, Roy S, Oskeritzian CA, Ali H. MRGPRX2 Activation by Rocuronium: Insights from Studies with Human Skin Mast Cells and Missense Variants. . 2021. PMID 33467419 · DOI · PMC7830812
- Gurunathan U, Kunju SM, Stanton LML. Use of sugammadex in patients with neuromuscular disorders: a systematic review of case reports. . 2019. PMID 31744470 · DOI · PMC6862738
- Shimizu K, Muraoka H, Fujita T, Hattori K, Nishikawa T, Uchitsubo H, et al.. Serial Fetal Heart Rate Monitoring During Electroconvulsive Therapy in Late Pregnancy: A Case Report of Transition From Succinylcholine to Rocuronium Reversed With Neostigmine. . 2026. PMID 42687377 · DOI · PMC13539057
- Tran DTT, Newton EK, Mount VAH, Lee JS, Mansour C, Wells GA, et al.. Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review. Anaesthesia. 2017. PMID 28654173 · DOI
- Richardson MG, Raymond BL. Sugammadex Administration in Pregnant Women and in Women of Reproductive Potential: A Narrative Review. Anesth Analg. 2020. PMID 31283616 · DOI
- Fernandes HDS, Ximenes JLS, Nunes DI, Ashmawi HA, Vieira JE. Failure of reversion of neuromuscular block with sugammadex in patient with myasthenia gravis: case report and brief review of literature. BMC Anesthesiol. 2019. PMID 31421671 · DOI · PMC6698336
- Couto M, Nunes C, Vide S, Amorim P, Mendes J. Rocuronium Continuous Infusion for Profound Neuromuscular Blockade: A Systematic Review and Meta-analysis. Clin Neuropharmacol. 2019. PMID 31725475 · DOI
- Lim BG, Won YJ, Kim H. The effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia: A systematic review and meta-analysis. Medicine (Baltimore). 2021. PMID 33592855 · DOI · PMC7870250
- Wang J, Cui Y, Liu B, Chen J. The efficacy of Antipyretic Analgesics administration intravenously for Preventing Rocuronium-Associated Pain/Withdrawal Response: a systematic review and meta-analysis. BMC Anesthesiol. 2020. PMID 32312228 · DOI · PMC7171835
About this article
- Sources
- NLM Medical Subject Headings (definition, synonyms); NCBI PubMed (counts, identifiers); Europe PMC (open-access abstracts and citation counts).
- Verification
- Every reference was resolved against PubMed on 2026-10-31; title, year and DOI matched.
- Review state
- automated source verified; no human expert review has been recorded yet.
- Version
- 1, last updated 2026-10-31.
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Evidence strength
EvidenceHelix's computed view of the study designs behind this topic: how common meta-analyses, randomized trials and reviews are, how recent the literature is, and a plain-language reading. It describes the design mix of the literature. It is not a quality appraisal of any study, and it is not medical advice.