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Anesthesia and Analgesia Oct 2002
Topics: Antiemetics; Cost-Benefit Analysis; Droperidol; Humans; Postoperative Nausea and Vomiting; United States; United States Food and Drug Administration
PubMed: 12351246
DOI: 10.1097/00000539-200210000-00001 -
Anaesthesia May 2010
Topics: Anesthesiology; Antiemetics; Antipsychotic Agents; Droperidol; History, 20th Century; Humans
PubMed: 20522036
DOI: 10.1111/j.1365-2044.2010.06315.x -
The American Journal of Emergency... Jul 1999The use of intramuscular droperidol to treat acute migraine headache has not been previously reported in the emergency medicine literature. It is a promising therapy for...
The use of intramuscular droperidol to treat acute migraine headache has not been previously reported in the emergency medicine literature. It is a promising therapy for migraine. The authors performed a pilot review of all patients receiving droperidol for migraine in our emergency department (ED) to evaluate its efficacy. We used a retrospective case series, in a suburban ED with an annual patient census of 48,000. All patients with a discharge diagnosis of migraine headache who were treated with i.m. droperidol during a consecutive 5-month period in our ED were identified. All patients received droperidol 2.5 mg intramuscular. As per ED protocol, their clinical progress was closely followed and documented at 30 minutes after drug administration (t30). Demographic and clinical variables were recorded on a standardized, closed-question, data collection instrument. The primary outcome measurement was relief of symptoms at t30 to the point that the patient felt well enough to go home without further ED intervention (symptomatic relief). Thirty-seven patients were treated (84% female), with an ED diagnosis of acute migraine with droperidol during the study period. The mean age was 36 +/- 12 years. Analgesics had been used within 24 hours before ED presentation by 62% of patients. At t30, 30 (81%) patients had symptomatic relief, 2 (5%) felt partial relief but required rescue medication, and 5 (14%) had no relief of symptoms. Drowsiness (14%) and mild akathisia (8%) were the only adverse reactions observed following drug administration. Droperidol 2.5 mg intramuscular may be a safe and effective therapy for the ED management of acute migraine headache. Randomized, controlled trials are warranted to further validate the findings of this preliminary study.
Topics: Acute Disease; Adult; Akathisia, Drug-Induced; Analgesics; Dopamine Antagonists; Droperidol; Female; Follow-Up Studies; Humans; Incidence; Injections, Intramuscular; Male; Migraine Disorders; Pilot Projects; Randomized Controlled Trials as Topic; Reproducibility of Results; Retrospective Studies; Sleep Stages; Time Factors; Treatment Outcome
PubMed: 10452443
DOI: 10.1016/s0735-6757(99)90096-7 -
The Medical Letter on Drugs and... Jun 2002
Topics: Adjuvants, Anesthesia; Arrhythmias, Cardiac; Dose-Response Relationship, Drug; Droperidol; Drug Approval; Humans
PubMed: 12058151
DOI: No ID Found -
Anesthesiology Apr 2002Droperidol is used in neuroleptanesthesia and as an antiemetic. Although its antiemetic effect is thought to be caused by dopaminergic inhibition, the mechanism of...
BACKGROUND
Droperidol is used in neuroleptanesthesia and as an antiemetic. Although its antiemetic effect is thought to be caused by dopaminergic inhibition, the mechanism of droperidol's anesthetic action is unknown. Because gamma-aminobutyric acid type A (GABAA) and neuronal nicotinic acetylcholine receptors (nAChRs) have been implicated as putative targets of other general anesthetic drugs, the authors tested the ability of droperidol to modulate these receptors.
METHODS
gamma-Aminobutyric acid type A alpha1beta1gamma2 receptor, alpha7 and alpha4beta2 nAChRs were expressed in Xenopus oocytes and studied with two-electrode voltage clamp recording. The authors tested the ability of droperidol at concentrations from 1 nm to 100 microm to modulate activation of these receptors by their native agonists.
RESULTS
Droperidol inhibited the GABA response by a maximum of 24.7 +/- 3.0%. The IC50 for inhibition was 12.6 +/- 0.47 nm droperidol. At high concentrations, droperidol (100 microm) activates the GABAA receptor in the absence of GABA. Inhibition of the GABA response is significantly greater at hyperpolarized membrane potentials. The activation of the alpha7 nAChR is also inhibited by droperidol, with an IC50 of 5.8 +/- 0.53 microm. The Hill coefficient is 0.95 +/- 0.1. Inhibition is noncompetitive, and membrane voltage dependence is insignificant.
CONCLUSIONS
Droperidol inhibits activation of both the GABAA alpha1beta1gamma2 and alpha7 nAChR. The submaximal GABA inhibition occurs within a concentration range such that it might be responsible for the anxiety, dysphoria, and restlessness that limit the clinical utility of high-dose droperidol anesthesia. Inhibition of the alpha7 nAChR might be responsible for the anesthetic action of droperidol.
Topics: Adjuvants, Anesthesia; Animals; Dose-Response Relationship, Drug; Droperidol; Female; GABA-A Receptor Antagonists; Neurons; Nicotinic Antagonists; Xenopus laevis
PubMed: 11964609
DOI: 10.1097/00000542-200204000-00029 -
Annals of Emergency Medicine Mar 2017We aim to determine the most efficacious of 3 common medication regimens for the sedation of acutely agitated emergency department (ED) patients. (Comparative Study)
Comparative Study Randomized Controlled Trial
STUDY OBJECTIVE
We aim to determine the most efficacious of 3 common medication regimens for the sedation of acutely agitated emergency department (ED) patients.
METHODS
We undertook a randomized, controlled, double-blind, triple-dummy, clinical trial in 2 metropolitan EDs between October 2014 and August 2015. Patients aged 18 to 65 years and requiring intravenous medication sedation for acute agitation were enrolled and randomized to an intravenous bolus of midazolam 5 mg-droperidol 5 mg, droperidol 10 mg, or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, droperidol 5 mg, or olanzapine 5 mg. The primary outcome was the proportion of patients adequately sedated at 10 minutes.
RESULTS
Three hundred forty-nine patients were randomized to the 3 groups. Baseline characteristics were similar across the groups. Ten minutes after the first dose, significantly more patients in the midazolam-droperidol group were adequately sedated compared with the droperidol and olanzapine groups: differences in proportions 25.0% (95% confidence interval [CI] 12.0% to 38.1%) and 25.4% (95% CI 12.7% to 38.3%), respectively. For times to sedation, the differences in medians between the midazolam-droperidol group and the droperidol and olanzapine groups were 6 (95% CI 3 to 8) and 6 (95% CI 3 to 7) minutes, respectively. Patients in the midazolam-droperidol group required fewer additional doses or alternative drugs to achieve adequate sedation. The 3 groups' adverse event rates and lengths of stay did not differ.
CONCLUSION
Midazolam-droperidol combination therapy is superior, in the doses studied, to either droperidol or olanzapine monotherapy for intravenous sedation of the acutely agitated ED patient.
Topics: Acute Disease; Adult; Benzodiazepines; Conscious Sedation; Double-Blind Method; Droperidol; Drug Therapy, Combination; Emergency Service, Hospital; Female; Humans; Hypnotics and Sedatives; Injections, Intravenous; Male; Midazolam; Olanzapine; Psychomotor Agitation
PubMed: 27745766
DOI: 10.1016/j.annemergmed.2016.07.033 -
The New England Journal of Medicine Jul 1981
Topics: Adult; Droperidol; Dystonia; Humans; Middle Aged
PubMed: 7242608
DOI: 10.1056/nejm198107233050420 -
Journal of Clinical PsychopharmacologyDroperidol is an antipsychotic medication used in psychiatric emergencies to manage acute behavioral disturbance. Droperidol use carries a risk of prolonged QT interval...
PURPOSE/BACKGROUND
Droperidol is an antipsychotic medication used in psychiatric emergencies to manage acute behavioral disturbance. Droperidol use carries a risk of prolonged QT interval on the electrocardiogram and associated cardiac arrhythmias including torsades de pointes and ventricular fibrillation. This study aimed to evaluate the safety of droperidol in adults admitted to the psychiatric inpatient unit of a large Australian hospital.
METHODS/PROCEDURES
In this retrospective cohort study, psychiatric inpatients admitted between October 22, 2018, and March 1, 2021, who received at least 1 dose of intramuscular droperidol were consecutively included. Outcomes of interest were death, cardiac arrhythmias, and QT prolongation. QT prolongation was identified using the QT-interval nomogram.
FINDINGS/RESULTS
This study included 263 patients without exclusion. No deaths or cases of cardiac arrhythmia were recorded within 24 hours of droperidol administration. Electrocardiogram data were available for 41.1% of patients (n = 108) within 7 days of droperidol administration. Two cases of QT prolongation were identified using the QT-interval nomogram, but these patients were also prescribed other medications that may have contributed to QT prolongation.
IMPLICATIONS/CONCLUSIONS
This study contributes the first known large retrospective study of safety outcomes including QT prolongation after droperidol administration in a psychiatric inpatient setting. Our findings corroborate mounting evidence supporting the clinical safety of droperidol use in psychiatric settings. Nonetheless, we note that significant barriers remain with regard to timely electrocardiogram monitoring after droperidol use.
Topics: Adult; Humans; Droperidol; Inpatients; Retrospective Studies; Australia; Long QT Syndrome; Arrhythmias, Cardiac; Torsades de Pointes; Electrocardiography
PubMed: 37068031
DOI: 10.1097/JCP.0000000000001688 -
Anesthesia and Analgesia Aug 1984
Topics: Anesthesia, Obstetrical; Anesthesia, Spinal; Cardiovascular Diseases; Droperidol; Female; Humans; Pregnancy
PubMed: 6465566
DOI: 10.1213/00000539-198408000-00016 -
British Journal of Clinical Pharmacology May 2014To investigate the QT interval after high dose droperidol using continuous 12-lead Holter recordings.
AIMS
To investigate the QT interval after high dose droperidol using continuous 12-lead Holter recordings.
METHODS
This was a prospective study of patients given droperidol with a continuous Holter recording. Patients were recruited from the DORM II study which included patients with aggression presenting to the emergency department. Patients initially received 10 mg droperidol as part of a standardized sedation protocol. An additional 10 mg dose was given after 15 min if required and further doses at the clinical toxicologist's discretion. Continuous 12-lead Holter recordings were obtained for 2-24 h utilizing high resolution digital recordings with automated QT interval measurement. Electrocardiograms were extracted hourly from Holter recordings. The QT interval was plotted against heart rate (HR) on the QT nomogram to determine if it was abnormal. QTc F (Fridericia's HR correction) was calculated and >500 ms was defined as abnormal.
RESULTS
Forty-six patients had Holter recordings after 10-40 mg droperidol and 316 QT-HR pairs were included. There were 32 abnormal QT measurements in four patients, three given 10 mg and one 20 mg. In three of the four patients QTc F >500 ms but only in one taking methadone was the timing of QTc F >500 ms consistent with droperidol dosing. Of the three other patients, one took amphetamines, one still had QT prolongation 24 h after droperidol and one took a lamotrigine overdose. No patient given >30 mg had a prolonged QT. There were no arrhythmias.
CONCLUSION
QT prolongation was observed with high dose droperidol. However, there was little evidence supporting droperidol being the cause and QT prolongation was more likely due to pre-existing conditions or other drugs.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Droperidol; Electrocardiography; Female; Humans; Male; Middle Aged; Prospective Studies
PubMed: 24168079
DOI: 10.1111/bcp.12272