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The American Journal of Emergency... Jul 2020Droperidol is a dopamine receptor antagonist that functions as an analgesic, sedative, and antiemetic. In 2001, the U.S. Food and Drug Administration required a black... (Observational Study)
Observational Study
BACKGROUND
Droperidol is a dopamine receptor antagonist that functions as an analgesic, sedative, and antiemetic. In 2001, the U.S. Food and Drug Administration required a black box warning in response to case reports of QT prolongation and potential fatal arrhythmias. The aim of this study was to evaluate the effectiveness and safety of droperidol in patients presenting to a United States Emergency Department (ED).
METHODS
Observational cohort study of all droperidol administrations from 1/1/2012 through 4/19/2018 at an academic ED. The primary endpoint was mortality within 24 h of droperidol administration. Secondary endpoint included use of rescue analgesics.
RESULTS
A total of 6,881 visits by 5,784 patients received droperidol of whom 6,353 visits authorized use of their records for research, including 5.4% administrations in children and 8.2% in older adults (≥65). Droperidol was used as an analgesic for pain (N = 1,387, 21.8%) and headache (N = 3,622, 57.0%), as a sedative (N = 550, 8.7%), and as an antiemetic (N = 794, 12.5%). No deaths secondary to droperidol administration were recorded within 24 h. Need for rescue analgesia occurred in 5.2% of patients with headache (N = 188) and 7.4% of patients with pain (N = 102); 1.1% of patients with headache received rescue opioids (N = 38) after droperidol, as did 5.4% of patients with pain other than headache (N = 75). No patients had fatal arrhythmias. Akathisia occurred in 2.9%.
CONCLUSION
No fatalities were seen among this large cohort of patients who received droperidol in the ED. Our findings suggest droperidol's effectiveness and safety when used as an analgesic, antiemetic and/or sedative.
Topics: Adjuvants, Anesthesia; Adult; Analgesics; Analgesics, Opioid; Antiemetics; Arrhythmias, Cardiac; Droperidol; Drug Labeling; Emergency Service, Hospital; Female; Headache; Humans; Hypnotics and Sedatives; Male; Middle Aged; Mortality; Pain; Retrospective Studies; United States
PubMed: 31831345
DOI: 10.1016/j.ajem.2019.09.007 -
The Journal of Pediatric Pharmacology... 2023As a result of recent legislative changes allowing for increased access to marijuana products, there have been increasing rates of cannabis abuse among adolescents and...
OBJECTIVE
As a result of recent legislative changes allowing for increased access to marijuana products, there have been increasing rates of cannabis abuse among adolescents and subsequent diagnoses of cannabinoid hyperemesis syndrome (CHS). Most available literature on this syndrome exists within the adult population and describes benzodiazepines, haloperidol, and topical capsaicin as potentially efficacious in the management of CHS. The objectives of this study were to identify antiemetics and compare their efficacy and safety in the management of pediatric CHS.
METHODS
A retrospective review of Penn State Children's Hospital electronic health record was performed to identify patients 18 years or younger who had an emergency department or inpatient encounter, a cannabis hyperemesis-related diagnosis code, and met diagnostic criteria for CHS. Antiemetic efficacy was determined using subjective patient perception of nausea and objective documentation of vomiting. Benzodiazepines, haloperidol, and topical capsaicin were classified as nontraditional antiemetics, whereas all other antiemetics were classified as traditional.
RESULTS
Nontraditional antiemetic medications appeared to be more effective in resolving patient symptoms compared with traditional antiemetics. Analysis of all ordered antiemetics demonstrated a gap in partial or full symptom resolution between nontraditional and traditional agents. Reported adverse effects were minimal.
CONCLUSIONS
Cannabinoid hyperemesis syndrome is an underrecognized and underdiagnosed condition characterized by cyclic vomiting related to chronic cannabis use. Abstinence from cannabis remains the most effective approach to mitigating morbidity associated with CHS. Medications such as lorazepam or droperidol may have benefit in managing toxidrome symptoms. Traditional antiemetic prescribing remains a key barrier to effective management of pediatric CHS.
PubMed: 37303765
DOI: 10.5863/1551-6776-28.3.222 -
Journal of Oral and Maxillofacial... Sep 2023In the fall of 2021, granisetron was approved for postoperative nausea and vomiting (PONV) management in Japan. However, the comparative efficacy of droperidol and...
BACKGROUND
In the fall of 2021, granisetron was approved for postoperative nausea and vomiting (PONV) management in Japan. However, the comparative efficacy of droperidol and granisetron in the field of orthognathic surgery has not been determined.
PURPOSE
We compare the efficacy of droperidol and granisetron for PONV prophylaxis following orthognathic surgery.
STUDY DESIGN, SETTING, SAMPLE
We performed a retrospective cohort study of patients who underwent orthognathic surgery at a single institution from September 2020 to December 2022. Patients who had undergone Le Fort I osteotomy with sagittal split ramus osteotomy or isolated sagittal split ramus osteotomy were included. Patients were divided into three groups; the isolated droperidol (D), isolated granisetron (G), and droperidol with granisetron (DG) groups. General anesthesia was performed using total intravenous anesthesia for all patients; however, droperidol and granisetron were administered at the anesthesiologist's discretion.
PREDICTOR VARIABLE
PONV prophylactic therapy included isolated droperidol, isolated granisetron, and droperidol with granisetron administration.
OUTCOME VARIABLES
Postoperative nausea (PON) and postoperative vomiting (POV) were determined through medical examination within 48 hours following surgery. Secondary outcomes included complications due to droperidol and/or granisetron administration.
COVARIATES
Age, sex, body mass index, Apfel's score, duration of surgery, duration of anesthesia, intraoperative blood loss, and type of surgery.
ANALYSES
Statistical analysis was conducted using Fisher exact test, Mann-Whitney U test with Bonferroni correction for univariate comparison, and modified Poisson regression for comparison of PON and POV prophylactic efficacy for multivariate analyses. P values <.05 were considered statistically significant.
RESULTS
Our study included 218 participants. There were no significant differences in covariates between groups D (n = 111), G (n = 52), and DG (n = 55). No significant difference in PON incidence was observed between groups. However, POV incidence was significantly lower in group DG than group D (relative risk, 0.21; 95% confidence interval, 0.05 to 0.86; P = .03). No significant difference in complication incidence was observed between groups.
CONCLUSIONS AND RELEVANCE
Granisetron was as effective as droperidol for PONV management, while droperidol combined with granisetron was more effective than isolated droperidol for POV management. As compared to the use of each drug separately, their combination was considered safe, with no increase in complication rates.
Topics: Humans; Droperidol; Granisetron; Postoperative Nausea and Vomiting; Retrospective Studies; Antiemetics; Orthognathic Surgery; Vomiting; Double-Blind Method
PubMed: 37277099
DOI: 10.1016/j.joms.2023.05.010 -
British Journal of Anaesthesia Jul 2023Postoperative nausea and vomiting (PONV) has been identified as a big (very frequently encountered) little (not linked to life-threatening outcomes) problem. Traditional...
Postoperative nausea and vomiting (PONV) has been identified as a big (very frequently encountered) little (not linked to life-threatening outcomes) problem. Traditional drugs (dexamethasone, droperidol or similar drugs, serotonin receptor antagonists) each have significant but limited effect, leading to an increasing use of combination therapies. High-risk patients, often identified through use of risk scoring systems, remain with a significant residual risk despite combining up to three traditional drugs. A recent correspondence in this Journal proposes the use of up to five anti-emetic drugs to further minimise the risk. This disruptive strategy was supported by favourable initial results, absence of side-effects and lower acquisition costs of the added new drugs (aprepitant and palonosetron) because of their recent loss of patent protection. These results are provocative and hypothesis generating, but need confirmation and do not warrant immediate changes in clinical practice. The next steps will also necessitate wider implementation of protocols protecting patients from PONV and a search for additional drugs and techniques aimed at treating established PONV.
Topics: Humans; Postoperative Nausea and Vomiting; Antiemetics; Droperidol; Serotonin Antagonists; Risk Factors; Vomiting; Dexamethasone; Drug Therapy, Combination
PubMed: 37179157
DOI: 10.1016/j.bja.2023.04.004 -
Journal of Clinical Monitoring and... Feb 2021Low-dose droperidol has been widely used as an antiemetic during and after surgery. Although high-dose droperidol affects motor-evoked potential, the effects of low-dose... (Randomized Controlled Trial)
Randomized Controlled Trial
Low-dose droperidol has been widely used as an antiemetic during and after surgery. Although high-dose droperidol affects motor-evoked potential, the effects of low-dose droperidol on motor-evoked potential amplitude are unclear. The aim of this study was to investigate whether low-dose droperidol affects motor-evoked potential amplitude. We retrospectively reviewed the data of patients who underwent spine surgery under general anesthesia with motor-evoked potential monitoring from February 2016 to 2017. The outcome was the motor-evoked potential amplitude of the bilateral abductor pollicis brevis muscle, tibialis anterior muscle, and abductor hallucis muscle within 1 and 1-2 h after droperidol administration, compared with the baseline motor-evoked potential value. Thirty-four patients were analyzed. The median dose of droperidol was 21 µg/kg. The motor-evoked potential amplitudes of all muscles were significantly reduced after droperidol administration and recovered to baseline values within 2 h. The reduction of all motor-evoked potential amplitudes after droperidol administration was 37-45% of baseline values. There were no significant differences in other drugs administered. There were no serious adverse effects of droperidol administration. Motor-evoked potential amplitude was suppressed by low-dose droperidol. During intraoperative motor-evoked potential monitoring in spine surgery, anesthesiologists should pay careful attention to the timing of administration of droperidol, even at low doses. Based on the results of this study, we are conducting a randomized controlled trial.
Topics: Anesthesia, General; Droperidol; Evoked Potentials, Motor; Humans; Monitoring, Intraoperative; Retrospective Studies
PubMed: 32067149
DOI: 10.1007/s10877-020-00464-4 -
Clinical Toxicology (Philadelphia, Pa.) Sep 2019Cannabinoid hyperemesis syndrome (CHS) can be characterized by recurrent paroxysmal episodes of intractable nausea and vomiting, abdominal pain, and compulsive hot...
Cannabinoid hyperemesis syndrome (CHS) can be characterized by recurrent paroxysmal episodes of intractable nausea and vomiting, abdominal pain, and compulsive hot showers/baths with symptom relief, on the background of chronic cannabis use. We reported the use of droperidol in the management of CHS. We performed a retrospective review of electronic medical records of Emergency Department presentations to a single tertiary level metropolitan hospital between January 2006 and December 2016 using search keywords: "cannabis", "cannabinoid", "cannabis", "hyperemesis", and "droperidol". A secondary search of pharmacy droperidol dispensing records was cross matched with electronic medical record data. We reviewed each record to determine if the presentation met previously published diagnostic criteria for CHS. Data were dichotomised into presentations with droperidol administered or not administered. The primary outcome was defined as the total length of hospital stay. Secondary outcomes measures included time until discharge following last drug administration, and the total number of antiemetic dosages administered. Six-hundred and eighty-nine records were identified and 76 met CHS diagnostic criteria. Thirty-seven presentations were treated with droperidol and 39 were not. Droperidol treatment group median length of stay was significantly lower compared to the no droperidol treatment group (6.7 vs. 13.9 hours, = .014). Median time to discharge after final drug administration in the droperidol treatment group was 137 minutes (IQR 65, 203) vs. the no droperidol treatment group of 185 minutes (IQR 149, 403). The most frequent dosage of droperidol used was 0.625mg intravenously. The frequency of ondansetron ( = 100) and metoclopramide ( = 27) in the no droperidol treatment group was double that of the droperidol group. Use of droperidol to treat CHS associated nausea and vomiting resulted in less overall use of antiemetics and reduced length of stay.
Topics: Adult; Antiemetics; Cannabis; Droperidol; Female; Humans; Male; Marijuana Abuse; Middle Aged; Retrospective Studies; Syndrome; Treatment Outcome; Vomiting; Young Adult
PubMed: 30729854
DOI: 10.1080/15563650.2018.1564324 -
Journal of Emergency Nursing May 2021After the increasing legalization of cannabis, there has been a rising trend in cannabis consumption, especially among heavy users. Cannabinoid hyperemesis syndrome is a... (Review)
Review
After the increasing legalization of cannabis, there has been a rising trend in cannabis consumption, especially among heavy users. Cannabinoid hyperemesis syndrome is a syndrome of cyclic vomiting related to chronic cannabis use. The difficulty of diagnosis and treatment of this syndrome has led to a disproportionately high use of health care resources. Although the exact mechanism of cannabinoid hyperemesis syndrome is still unknown, patients typically progress through prodromal, hyperemetic, and recovery phases. Persistent vomiting in a patient who reports relief with hot showers should trigger the consideration of cannabinoid hyperemesis syndrome as a possible diagnosis. For treatment, antipsychotics such as haloperidol or droperidol have been shown to be more effective than conventional antiemetics for symptom control. Capsaicin should also be considered, given its positive efficacy and low adverse-effect profile. Providers must be aware of cannabinoid hyperemesis syndrome, its diagnosis, and treatment, given the increasing prevalence. Further research is required to elicit the exact mechanism and additional therapies for this syndrome.
Topics: Antiemetics; Cannabinoids; Humans; Marijuana Abuse; Syndrome; Vomiting
PubMed: 33712244
DOI: 10.1016/j.jen.2020.11.006 -
BMC Anesthesiology Oct 2023There are limited real-world data regarding the use of droperidol for antiemetic prophylaxis in intravenous patient-controlled analgesia (IV-PCA). This study aimed to...
BACKGROUND
There are limited real-world data regarding the use of droperidol for antiemetic prophylaxis in intravenous patient-controlled analgesia (IV-PCA). This study aimed to evaluate the antiemetic benefits and sedation effects of droperidol in morphine-based IV-PCA.
METHODS
Patients who underwent major surgery and used morphine-based IV-PCA at a medical center from January 2020 to November 2022 were retrospectively analyzed. The primary outcome was the rate of any postoperative nausea and/or vomiting (PONV) within 72 h after surgery. Propensity score matching was used to match patients with and without the addition of droperidol to IV-PCA infusate in a 1:1 ratio. Multivariable conditional logistic regression models were used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs).
RESULTS
After matching, 1,104 subjects were included for analysis. The addition of droperidol to IV-PCA reduced the risk of PONV (aOR: 0.49, 95% CI: 0.35-0.67, p < 0.0001). The antiemetic effect of droperidol was significant within 36 h after surgery and attenuated thereafter. Droperidol was significantly associated with a lower risk of antiemetic uses (aOR: 0.58, 95% CI: 0.41-0.80, p = 0.0011). The rate of unintentional sedation was comparable between the patients with (9.1%) and without (7.8%; p = 0.4481) the addition of droperidol. Postoperative opioid consumption and numeric rating scale acute pain scores were similar between groups.
CONCLUSIONS
The addition of droperidol to IV-PCA reduced the risk of PONV without increasing opiate consumption or influencing the level of sedation. However, additional prophylactic therapies are needed to prevent late-onset PONV.
Topics: Humans; Antiemetics; Droperidol; Postoperative Nausea and Vomiting; Morphine; Cohort Studies; Retrospective Studies; Analgesia, Patient-Controlled; Propensity Score; Double-Blind Method
PubMed: 37898746
DOI: 10.1186/s12871-023-02319-2 -
The American Journal of Emergency... Jul 2023Acute agitation and violent behavior in the emergency department (ED) can lead to significant patient morbidity and contribute to the growing problem of workplace... (Observational Study)
Observational Study
PURPOSE
Acute agitation and violent behavior in the emergency department (ED) can lead to significant patient morbidity and contribute to the growing problem of workplace violence against health care providers. To our knowledge, there is no available literature directly comparing intramuscular ketamine to intramuscular droperidol in ED patients presenting with undifferentiated agitation. The purpose of this investigation was to compare the effectiveness and safety of these agents for acute agitation in the ED.
METHODS
This was a retrospective observational study conducted at an urban, academic ED. The primary endpoint was time from the first dose of study medication to restraint removal. Safety endpoints included incidence of bradycardia (heart rate < 60 bpm), hypotension (systolic blood pressure < 90 mmHg), hypoxia (oxygen saturation < 90% or need for respiratory support), and incidence of intubation for ongoing agitation or respiratory failure.
RESULTS
An initial 189 patients were screened, of which, 92 met inclusion criteria. The median time from initial drug administration to restraint removal was 49 min (IQR 30, 168) in the ketamine group and 43 min (IQR 30, 80) in the droperidol group (Median difference 6 min; 95% CI [-7, 26]). There was no significant difference in rates of bradycardia (3% vs 3%, 95% CI [-7%, 8%]), hypotension (0% vs 2%, 95% CI [-5%, 2%]), or hypoxia (7% vs 10%, 95% CI [-15%, 9%]) in the ketamine versus droperidol groups respectively. One patient in the ketamine group was intubated for ongoing agitation, and one patient in the droperidol group was intubated for respiratory failure.
CONCLUSIONS
Intramuscular droperidol and intramuscular ketamine were associated with similar times from drug administration to restraint removal in patients presenting to the ED with undifferentiated agitation. Prospective studies are warranted to evaluate IM droperidol and IM ketamine head-to-head as first line agents for acute agitation in the ED.
Topics: Humans; Droperidol; Ketamine; Retrospective Studies; Bradycardia; Psychomotor Agitation; Emergency Service, Hospital; Respiratory Insufficiency
PubMed: 37031618
DOI: 10.1016/j.ajem.2023.03.058 -
Cureus Jun 2023Introduction Headaches are a common presentation to the emergency department, representing approximately 3% of visits. The standard treatment of headaches has consisted...
Introduction Headaches are a common presentation to the emergency department, representing approximately 3% of visits. The standard treatment of headaches has consisted of either monotherapy with an antidopaminergic agent or combination therapy with an antidopaminergic agent, a non-steroidal anti-inflammatory drug (NSAID), and diphenhydramine. Although droperidol is an antidopaminergic medication, it previously was not widely used in the treatment of headaches due to safety concerns. Given its pharmacokinetics, droperidol may provide faster relief in migrainous headaches compared to more commonly used antidopaminergic agents. Methods We conducted a single-center retrospective chart review to examine the impact of droperidol compared to other standard migraine therapies on pain scores. The study consisted of three treatment arms: droperidol monotherapy, a droperidol bundle (droperidol and ketorolac), and a prochlorperazine bundle (prochlorperazine and ketorolac). Patients who received medications in treatment arms and who had an encounter diagnosis including either "headache" or "migraine" were included. Patients were excluded if under 18 years of age, imprisoned, pregnant, or received potentially migraine-altering medications prior to the first documented pain score. The primary outcome was a mean reduction in pain scores. Secondary outcomes included length of emergency department stay, rates of inpatient admission, need for rescue therapies, and adverse events. Results A total of 361 droperidol orders were reviewed, of which 79 met the inclusion criteria. Of those included, 30 orders were within the droperidol monotherapy arm, 19 were within the droperidol bundle arm, and 30 were within the prochlorperazine bundle arm. There were no significant differences in reduction of pain scores, emergency department length of stay, rates of inpatient admission, rates of rescue therapy, or adverse events between the three treatment arms. Conclusion In this study, we found no statistical difference in migraine treatment efficacy between droperidol monotherapy and droperidol and prochlorperazine-based bundle therapies. Further studies are needed with larger sample sizes and predefined timing between pain score charting and medication administration.
PubMed: 37404431
DOI: 10.7759/cureus.39848