Doses Of Droperidol Research Articles

Droperidol administration among emergency department patients with abdominal pain, nausea, and vomiting

Study objectiveThe primary objective of this study was to examine the common usage patterns of droperidol in the relatively unrestricted environment of an urban, academic medical center. We focused specifically on the most common use of droperidol in our department: patients with a chief complaint of abdominal pain, nausea, and/or vomiting. MethodsFor this retrospective, observational, single-center study, we extracted records of all administrations of droperidol from August 2019 to August 2020. Patients with a chief complaint of abdominal pain, nausea, or vomiting, or any combination thereof, were included in data analysis. ResultsBetween April 2019 to August 2020, 830 discrete patient visits involving droperidol administration were identified, comprising 706 patients. The average age was 39 years old with a range of 15 to 80. Seven patients (0.08%) were younger than 18, and 35 (4%) were older than 65. Five hundred sixty-five patients (68%) were female. Droperidol doses ranged from 0.625 mg to 5 mg intravenous (IV), with a median dose of 0.625 mg (interquartile range 0.625–1.25 mg), with 590 patients (71%) receiving a dose of 0.625 mg. Only 19 patients (2.3%) had a documented adverse event. Seven had akathisia or restlessness, 7 had anxiety or agitation, 3 had dystonia or stiffness, 1 had fatigue, and 1 had dizziness. For the entire cohort, there were no cardiac dysrhythmias, syncope, seizures, other major adverse events, or fatalities recorded. ConclusionAt one institution, droperidol is being used commonly for the chief complaints of abdominal pain, nausea, and/or vomiting. The preferred dosing is nearly universally below the 2.5 mg IV dose for which the FDA warning applies. Similar to previous studies, identification of adverse events was rare, and no major adverse outcomes such as dysrhythmia or death were identified.

Preoperative Femoral Nerve Block and Postoperative Sciatic Nerve Block at the Subgluteal Space After Total Knee Arthroplasty: A Retrospective Cohort Study.

Background A preoperative sciatic nerve block (SNB) before total knee arthroplasty (TKA) frequently causes postoperative drop foot; however, this can also occur as an unintended result of surgical invasion. This study assessed the benefits of a postoperative SNB at the subgluteal space for patients who underwent TKA. Methodology This was a single-center, retrospective cohort study. Patients who underwent TKA under general anesthesia between May 2018 and June 2019 at the Teikyo University School of Medicine were screened for inclusion. They received either a preoperative femoral nerve block alone (control group; n = 87) or a preoperative femoral nerve block and postoperative SNB at the subgluteal space (post-SNB group; n = 40). The primary outcome was the pain-related Numerical Rating Scale (NRS) scores. The secondary outcomes were postoperative nausea and vomiting (PONV), intravenous patient-controlled analgesia (iv-PCA) suspension, and postoperative complications. Results No significant differences were observed in the characteristics, NRS scores, time to first drug use for pain, and iv-PCA suspension between groups. However, the incidence of PONV was significantly lower in the post-SNB group (p = 0.03). Logistic regression analysis revealed that droperidol doses of iv-PCA and the presence of postoperative SNB were independently associated with PONV occurrence [A1]{(p = 0.008, 95% confidence intervals (CI) [0.46, 0.89] and (p = 0.02, 95% CI [0.25, 0.88])}. Conclusions A postoperative SNB at the subgluteal space following TKA does not improve postoperative pain control; however, it may have contributed to reduced PONV.

Droperidol lowers the shivering threshold in rabbits.

Perioperative shivering is common and can occur as a result of hypothermia or changes in the threshold of thermoregulation. Droperidol usage for anesthesia is currently limited to its sedative and antiemetic effects. We investigated the effects of high and low doses of droperidol on the shivering threshold in rabbits. Forty-two male Japanese white rabbits were anesthetized with isoflurane and randomly assigned to the control, high-dose, or low-dose group. Rabbits in the high-dose group received a 5mg/kg droperidol bolus followed by continuous infusion at 5mg/kg/h, those in the low-dose group received a 0.5mg/kg droperidol bolus, and those in the control group received the same volume of saline as the high-dose group. Body temperature was reduced at a rate of 2-3°C/h, and the shivering threshold was defined as the subject's core temperature (°C) at the onset of shivering. The shivering thresholds in the control, high-dose, and low-dose groups were 38.1°C ± 1.1°C, 36.7°C ± 1.2°C, and 36.9°C ± 1.0°C, respectively. The shivering thresholds were significantly lower in the high-dose and low-dose groups than in the control group (P < 0.01). The thresholds were comparable between the high-dose and low-dose groups. Droperidol in high and low doses effectively reduced the shivering threshold in rabbits. Droperidol has been used in low doses as an antiemetic. Low doses of droperidol can reduce the incidence of shivering perioperatively and during the induction of therapeutic hypothermia.

Droperidol in the Management of Phantom Limb Pain: Case Report.

Phantom limb pain (PLP) is a poorly understood phenomenon experienced by amputees. The pain is typically classified as neuropathic, and there is no established first-line therapy. Droperidol is an antipsychotic with a wide array of pharmacologic activity including gamma-aminobutyric acid-A channel modulation, μ opioid receptor potentiation, dopamine-2-receptor blockade, and alpha-2-receptor agonism. Due to this broad therapeutic activity, droperidol is used for many off-label indications. Our patient was a 25-year-old male with a history of lower limb amputation who presented for evaluation and management of an acute exacerbation of PLP. On arrival, the patient was in 10/10 pain (numeric pain rating scale) described as cramping and burning. He had been previously successfully managed with subdissociative ketamine. However, during a recent exacerbation he experienced an emergence reaction to ketamine. Literature guiding pharmacotherapy in the management of PLP is sparse and of low quality. Based on the prior emergence reaction to subdissociative ketamine we explored other pharmacotherapy options. Droperidol has a wide array of pharmacologic activity and is used off label for the management of some pain syndromes. Therefore, we administered an intravenous dose of droperidol 5 milligrams. Approximately 15 minutes after receiving droperidol the patient's pain was visibly improved, and 30 minutes later he rated his pain at 3/10. The success in treating this patient provides encouragement for future research and bolsters confidence that droperidol could be another tool in the management of complex pain syndromes.

CPNP 2022 Annual Meeting Poster Abstracts

CPNP 2022 Annual Meeting Poster Abstracts

Prospective real-time evaluation of the QTc interval variation after low-dose droperidol among emergency department patients.

To assess the QTc interval variation after low-dose droperidol in a population of undifferentiated, stable, and non-agitated patients receiving droperidol in the emergency department. Prospective cohort study of patients aged ≥12years of age who received low-dose droperidol (≤ 2.5mg) for indications other than acute behavioral disturbances. QTc intervals were monitored in real-time during pre-specified observation periods in the ED. Primary outcome was variation of QTc interval after droperidol administration, defined as the maximum delta (change) of QTc interval. Other outcomes included proportion of patients with a QTc≥500ms after droperidol, delta≥+60ms, and incidence of clinical adverse events. Patients were monitored up to 30min after IV bolus and up to 46min after infusion. A total of 68 patients were included (mean age 42.1years, 66.2% females). The median dose of droperidol was 1.875mg (range 0.625mg, 2.5mg) and 94.1% received droperidol for headache management. Most patients received droperidol as a 2-min bolus (n=41, 60.3%). The mean maximum delta of QTc interval after droperidol across all 68 patients was +29.9ms (SD 15). A total of 12 patients (17.6%) experienced a QTc interval≥500ms during the observation period after droperidol, and 3 patients (4.4%) had a delta QTc≥+60ms. There were no serious arrhythmias, such as TdP, or deaths among the 68 participants in this study (0/68). However, 13.2% (n=9) had at least one non-serious adverse event including restlessness and/or anxiety. The QTc interval slightly increased after droperidol administration, but these prolongations were brief, mostly below 500msec and did not lead to serious arrhythmias. The yield of continuous cardiac monitoring in patients receiving low doses of droperidol is likely low.

The Incidence of QT Prolongation and Torsades des Pointes in Patients Receiving Droperidol in an Urban Emergency Department.

IntroductionDroperidol carries a boxed warning from the United States Food and Drug Administration for QT prolongation and torsades des pointes (TdP). After a six-year hiatus, droperidol again became widely available in the US in early 2019. With its return, clinicians must again make decisions regarding the boxed warning. Thus, the objective of this study was to report the incidence of QT prolongation or TdP in patients receiving droperidol in the ED.MethodsPatients receiving droperidol at an urban Level I trauma center from 1997–2001 were identified via electronic health record query. All patients were reviewed for cardiac arrest. We reviewed electrocardiogram (ECG) data for both critically-ill and noncritical patients and recorded Bazett’s corrected QT intervals (QTc). ECGs from critically-ill patients undergoing resuscitation were further risk-stratified using the QT nomogram.ResultsOf noncritical patients, 15,374 received 18,020 doses of droperidol; 2,431 had an ECG. In patients with ECGs before and after droperidol, the mean QTc was 424.3 milliseconds (ms) (95% confidence interval [CI], 419.7–428.9) before and 427.6 ms (95% CI, 424.3–430.9), after droperidol (n = 170). Regarding critically-ill patients, 1,172 received droperidol and 396 had an ECG. In the critically-ill group with ECGs before and after droperidol mean QTc was 435.7 ms (95% CI, 426.7–444.7) before and 435.8 ms (95% CI, 427.5–444.1) after droperidol (n = 114). Of 337 ECGs suitable for plotting on the QT nomogram, 13 (3.8%) were above the “at-risk” line; 3/136 (2.2%; 95% CI, 0.05–6.3%) in the before group, and 10/202 (4.9%; 95% CI, 2.4%–8.9%) in the after group. A single case of TdP occurred in a patient with multiple risk factors that did not reoccur after a droperidol rechallenge. Thus, the incidence of TdP was 1/16,546 (0.006%; 95% CI, 0.00015 – 0.03367%).ConclusionWe found the incidence of QTc prolongation and TdP in ED patients receiving droperidol to be extremely rare. Our data suggest the FDA “black box warning” is overstated, and that close ECG monitoring is useful only in high-risk patients.

Low-dose droperidol suppresses transcranial electrical motor-evoked potential amplitude: a retrospective study.

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.

312 Low-Dose Droperidol Administration Does Not Result in Adverse Outcomes in Patients With QTc >500 msec

Droperidol is a dopamine D2 receptor antagonist, antipsychotic used extensively by emergency physicians, psychiatrists and anesthesiologists worldwide since 1967. The United States Food and Drug Administration (FDA) issued a black box warning on the use of droperidol due to concerns of QT prolongation and potential fatal arrhythmias. Despite this, studies have found data supporting safe usage of low doses of droperidol, and its effectiveness in treating acute migraine headaches in the emergency department (ED) as well for sedation. Our objective was to evaluate mortality and QTc prolongation among patients who received droperidol. This was an observational cohort study of all droperidol administrations in the ED from 1/1/2012 through 4/19/2018 at an academic quaternary center with 77,000 visits. The primary endpoint was mortality within 24 hours of droperidol administration. Secondary endpoints included QTc length up to 6 months before droperidol and within 24 hours after droperidol administration. A random sample of 10% was manually reviewed to assess the accuracy of the electronic data retrieval. QTc>500 msec was considered prolonged in both males and females. Zero deaths attributable to droperidol administration were recorded within 24 hours from the entire cohort of 6,881 visits. Among the manually reviewed records (N=796), the median droperidol dose was 0.625 mg, representing 52.1% visits with this dose. 40.5% (N=322) of patients received a dose close to 2.5 mg, and 2.4% (N=19) received 5 mg of droperidol. There were 2.9% (N=23) documented cases of akathisia, that resolved with diphenhydramine in every case. Visits over the study time period with an ECG within 6 months before droperidol administration and within 24 hours following droperidol were reviewed. There were 2,080 patients with EKG obtained within 6 months prior and 1,631 with and EKG within 24 hours after administration. There were 77 patients who had a QTc ≥500 prior to droperidol administration, and 43 patients with an ECG within 24 hours following droperidol administration that demonstrated a QTc ≥500, including 8 with a QTc ≥500 within 6 months before droperidol. We found no increased mortality among the 6,881 patients who received droperidol. QTc was prolonged in 0.7% of cases after droperidol administration, and this did not result in patient significant outcomes. Our study confirms the findings by The Clinical Guideline Committee of the American Academy of Emergency Medicine which found no evidence that low-dose droperidol was unsafe for use in the ED.

Clinical evaluation of postoperative nausea and vomiting after cleft lip and/or palate surgery in pediatric patients. Part 2: evaluation of preventive administration of droperidol in combination with dexamethasone.

This study aimed to evaluate the effect of preventive administration of the combination of droperidol and dexamethasone on lowering the risk for postoperative nausea and vomiting (PONV) after cleft-related surgery in pediatric patients. Preventive care consisted of a single dose of droperidol (0.025mg/kg) and dexamethasone (0.06mg/kg), which were administered at the end of surgery. The effect of preventive administration was evaluated in a sample group of 58 patients aged ≥3 years who underwent cleft-related surgery. Thirty patients received preventive administration (prevention group) and 28 patients did not (comparative group). The following outcome variables were evaluated between the groups: sex, age, body weight at the time of surgery, and duration of anesthesia. The presence or absence of PONV was the primary outcome and other variables were considered as explanatory variables. The incidence rate of PONV was 20% (6/30) in the prevention group and 28.6% (8/28) in the comparative group, with no significant difference between the groups (p=0.45). In multiple logistic regression analysis, sex was the only explanatory factor of PONV, with a higher risk in girls than in boys (odds ratio, 6.20; 95% confidence interval, 1.65-27.63; p=0.01). The incidence rate of PONV is 20% with preventive care of droperidol and dexamethasone administration, but this rate is not different from that without this combination. Sex is a risk factor for PONV. Further studies are required to validate our results.

Incidence of akathisia after postoperative nausea and vomiting prophylaxis with droperidol and ondansetron in outpatient surgery: A multicentre controlled randomised trial.

Akathisia, a distressing movement disorder induced by butyrophenones, has been described with low doses of droperidol used for postoperative nausea and vomiting (PONV) prophylaxis, but the incidence remains unclear. To determine the incidence of akathisia after PONV prophylaxis with two doses of droperidol in comparison with ondansetron, in patients undergoing ambulatory surgery. We hypothesised that the incidence of akathisia is higher with droperidol than that with ondansetron. Randomised controlled double blind trial. Two University Hospital Centres and two private Clinics from January to September 2014. Patients (n=297) undergoing general anaesthesia for ambulatory surgery were randomly allocated to receive PONV prophylaxis with droperidol (0.625 or 1.25 mg) or ondansetron 4 mg; patients of the three groups also received 4 mg of dexamethasone. Exclusion criteria were contraindication to droperidol and ondansetron, use of psychotropic medications or benzodiazepines or history of psychotic illness. Participants received droperidol (0.625 or 1.25 mg) or ondansetron 4 mg during general anaesthesia. After discharge from the postanaesthesia care unit presence and severity of akathisia were assessed using the Barnes Akathisia Rating Scale at 4 h postoperatively. Score of the Global Clinical Assessment of Akathisia of Barnes Akathisia Rating Scale. The number of akathisia observed was 1/118 (0.8%) in the ondansetron group, 1/84 (1.2%) in droperidol 0.625 mg group, and 3/87 (3.4%) in droperidol 1.25 mg group. The akathisia rate difference among the three groups was not significant (P = 0.52). We could not demonstrate significant differences in the incidence of akathisia between the two doses of droperidol. The only case of marked akathisia treated with benzodiazepines was observed after droperidol 1.25 mg. The use of droperidol or ondansetron for PONV prophylaxis is associated to a low incidence of akathisia (0.8 to 3.4%) after general anaesthesia for ambulatory surgery. Clinicaltrials.gov: NCT01942343.

Parenteral Antipsychotic Choice and Its Association With Emergency Department Length of Stay for Acute Agitation Secondary to Alcohol Intoxication.

Acute agitation secondary to alcohol intoxication frequently requires parenteral sedatives for patient and caregiver safety. Antipsychotics play a prominent role; however, no consensus exists regarding the ideal agent. One important consideration when evaluating the choice of antipsychotic is its association with emergency department (ED) length of stay (LOS). We sought to determine the median ED LOS for patients receiving a single parenteral dose of an antipsychotic for acute agitation secondary to alcohol intoxication in an urban Level I trauma center. This was a retrospective review of patients receiving a single parenteral dose of droperidol, haloperidol, or olanzapine who were acutely intoxicated on alcohol from 2011 to 2016. Patients needing psychiatric assessment in our ED are discharged to a geographically separate department; thus, ED LOS is minimally impacted by waits for psychiatric assessment. Data were abstracted from the electronic medical record and are presented descriptively. A total of 40,601 patients were identified and screened; 24,319 patients were intoxicated but received no sedation. Of those remaining 4,495 received multiple drugs and/or benzodiazepines leaving 11,787 for analysis. Median age was 42 years, 76% were male, and 5% of patients were admitted. Mean breath ethanol concentration was 227 mg/dL. Antipsychotics administered were as follows: droperidol (n=3,790), haloperidol (n=1,449), and olanzapine (n=6,548). Median ED LOS was shortest for droperidol (499 minutes, 95% confidence interval [CI]= 493-506 minutes), which was significantly shorter than both haloperidol (524 minutes, 95% CI= 515-537 minutes) and olanzapine (533 minutes, 95% CI= 528-539 minutes). No cases of sudden cardiac death occurred. Droperidol, when given as monotherapy for sedation of acute agitation secondary to alcohol intoxication, was associated with significantly shorter ED LOS than either parenteral haloperidol or parenteral olanzapine. No difference in ED LOS was observed between haloperidol and olanzapine.

A low dose of droperidol decreases the desflurane concentration needed during breast cancer surgery: a randomized double-blinded study.

BackgroundDroperidol (DHB) reportedly reduces the dose of propofol needed to achieve hypnosis when anesthesia is induced and decreases the bispectral index (BIS) in propofol-sedated patients during spinal anesthesia. We reported previously that supplemental DHB decreased the BIS after the administration of sevoflurane and remifentanil. This study investigated the effect of DHB on desflurane (DES) consumption in a clinical setting.MethodsWe conducted a prospective, randomized double-blinded study of 35 women with American Society of Anesthesiologist physical status I or II who underwent a mastectomy. Either DHB (20 µg/kg) or a saline placebo was administered to patients 30 min after the induction of anesthesia. A blinded anesthesiologist maintained a BIS value of 50 during anesthesia by modulating inhaled DES concentrations that changed 0.5% at 2.5 min intervals and maintained analgesia via the constant administration of remifentanil by referring to vital signs. The primary endpoint was the effect of DHB on DES consumption. The secondary endpoints included blood circulatory parameters, the time from the end of surgery to extubation, and discharge time between the groups.ResultsThe characteristics of the patients did not differ between the groups. The DHB group used a mean of 27.2 ± 6.0 ml of DES compared with 41.4 ± 9.5 ml by the placebo group (P < 0.05).ConclusionsA small dose of DHB reduced the DES concentration needed to maintain a BIS of 50. Our results show that DHB reduced the consumption of DES without adverse effects.

Targeting islet cell using 18F-Fallypride: in vitro and histoautoradiography study

Objective To evaluate the feasibility of dopamine D2 receptor imaging agent (s)-(-)-N-(1-allylpyrrolidine-2-N-methyl)-5-(3-18F)-2, 3-dimethoxy Benzamide (18F-Fallypride) for targeting islet cell imaging. Methods (1) Cytology experiment: Islet cells of 15×103 cells/well were incubated with 3.70 kBq/well 18F-Fallypride for 1 h and the uptake rate of cells was calculated (cell counts/(supernatant counts+cell counts)×100%). Under the same experiment conditions, 6 inhibiting groups were administrated with different concentration of dopamine inhibitors droperidol (1.0×10-6, 4.0×10-6, 2.0×10-5, 1.0×10-4, 5.0×10-4 and 1.0×10-3 mol/L, respectively). After 30 min, 3.70 kBq of 18F-Fallypride was added to each inhibiting group, and the inhibiting rate was calculated. (2) Autoradiography: 18 normal ICR mice were divided into 6 groups. For group A, ICR mice were injected with 18F-Fallypride (55±5) MBq/mice through tail vein. For the other 5 inhibiting groups (group B-F), ICR mice were injected with different doses of droperidol (0.2, 0.4, 0.6, 0.8 and 1.0 mg/kg, respectively), and after 30 min 18F-Fallypride were injected through tail vein. Ten minutes later, pancreas of ICR mice was taken for preparation of tissue section autoradiography. The data were analyzed by one-way analysis of variance and the least significant difference t test. Results (1) The 18F-Fallypride uptake rate of control group was (18.40±1.21)%. The uptake rates of inhibiting groups were (16.11±1.37)%, (15.76±0.99)%, (13.90±1.02)%, (8.86±0.73)%, (7.26±0.62)% and (6.92±0.58)%, respectively, which decreased with the decreasing concentration of droperidol(F=50.01, P<0.01). When the concentration of droperidol was 1.0×10-4 mol/L, the uptake rate reached the lowest with inhibiting rate of 51.85%. (2) The autoradiography showed that the pancreas gray scale value of group A was 1.21×106 digital light units (DLU)/mm2. The pancreas gray scale value of groups B to F decreased with increasing concentration of inhibitor: 0.93×106, 0.77×106, 0.59×106, 0.32×106 and 0.25×106 DLU/mm2, respectively. Conclusions 18F-Fallypride may specifically and efficiently bind to dopamine receptors of islet cells. It may be a potential tracer for islet cells imaging. Key words: Islets of langerhans; Fallypride; Fluorine radioisotopes

The Safety and Effectiveness of Droperidol for Sedation of Acute Behavioral Disturbance in the Emergency Department

We investigate the safety and effectiveness of droperidol for sedation of acute behavioral disturbance in the emergency department (ED). This was a prospective observational study in 6 EDs (August 2009 to April 2013). Adult patients requiring parenteral sedation for acute behavioral disturbance received droperidol 10 mg. If this did not sedate the patient within 15 minutes, further sedation was allowed but droperidol 10 mg was recommended as part of a sedation protocol. The primary outcome was the proportion of patients with an abnormal QT interval, defined by the at-risk line on the QT nomogram. Secondary outcomes were effectiveness determined by the time to sedation measured on the Sedation Assessment Tool, use of additional sedation, adverse events, and injury to staff or patients. There were 1,009 patients with an ECG performed within 2 hours of droperidol administration, with a median dose of 10 mg (interquartile range [IQR]10 to 17.5 mg). Thirteen of the 1,009 patients had an abnormal QT (1.3%; 95% confidence interval 0.7% to 2.3%), but 7 of these had another cause attributed for prolonged QT (methadone, escitalopram, amiodarone, or preexisting). In 1,403 patients sedated with a median total dose of droperidol of 10 mg (IQR 10 to 20 mg), the median time to sedation was 20 minutes (IQR 10 to 30 minutes) and 97% were sedated within 120 minutes. Additional sedation was required for 435 patients (31.0%; 95% confidence interval 28.6% to 33.5%). Adverse events occurred in 70 patients (5%) and oversedation without complications in 109 (8%), the latter more common for patients receiving benzodiazepines as additional sedation (16/109 [15%]). There were no cases of torsades de pointes. Injuries occurred in 34 staff members and 4 patients. The study supports the use of high-dose droperidol as a safe sedating agent for patients with acute behavioral disturbance in the ED. There is no evidence of increased risk for QT prolongation with the doses used in this study.

Small doses of droperidol do not present relevant torsadogenic actions: a double-blind, ondansetron-controlled study.

Drugs used for postoperative nausea and vomiting prophylaxis are believed to provoke torsadogenic changes in cardiac repolarization. The aim of this study was to assess the effect of small doses of droperidol on the parameters of cardiac repolarization, including the QTc interval and transmural dispersion of repolarization. A total of 75 patients were randomly allocated to receive 0.625 or 1.25 mg droperidol or 8 mg ondansetron. The QTc interval was calculated using Bazett's formula and the Framingham correction. The transmural dispersion of repolarization was determined as Tpeak -Tend time. Transient QT prolongation, corrected with both formulae, followed 1.25 mg of droperidol 10 min after administration. No change in the QTc value was observed in the other groups. When corrected with Bazett's formula, QTc was prolonged above 480 ms in two patients receiving 1.25 mg droperidol (at the 10(th) and 20(th) minute of the study) and in one receiving ondansetron. No patients developed a QTc B prolongation over 500 ms. No increase above 480 ms was observed relative to the Framingham correction method. There were no significant differences in the Tpeak -Tend time either between or within the groups. In men without cardiovascular disorders small doses (1.25 mg) of droperidol prophylaxis induced transient QTc prolongation without changes in transmural dispersion of repolarization. The apparently low risk of the drug applies only in low risk male patients with a low pro-QTc score.

Efficacy and Tolerability of Antipsychotics in Treatment of Agitation and Aggression Following Traumatic Brain Injury (Tbi): Systematic Review of Clinical Trials

Introduction Aggression is a common consequence of traumatic brain injury (TBI). Agitation may be predictive of longer length of inpatient care and poor progress. Objectives To evaluate the efficacy and tolerability of Antipsychotics for management of aggression in TBI. Aims Systematic review of RCT's to evaluate efficacy and tolerability of Antipsychotics in treatment of aggression in TBI. Method MEDLINE, PubMed, Psychinfo, Embase searched from 1990 till 2014 . Search terms Brain Injury, Head injury, Traumatic Brain Injury, Agitation, Aggression, Violence, Irritability, Episodic dyscontrol, Antipsychotic medication were used. Result 50 papers were screened based on pre-set criteria. 3 clinical trials were identified for final analysis. 1 study compared oral haloperidol and oral droperidol; the second study compared intramuscular droperidol and haloperidol. The third study compared oral Quetiapine and Chlorpromazine. Jadad scale was used to assess the quality of trials.1 study reached a Jadad score of 3, the other two did not score. Better tolerability reported for Quetiapine, which was effective in reducing aggression in doses of 25mg to 300mg. Time to achieve calming was significantly shorter with intramuscular droperidol (mean = 27 minutes) compared to intramuscular haloperidol (mean = 43 minutes). Single doses of droperidol controlled agitation more frequently and with less post-episodic sedation. Oral haloperidol and droperidol did not show differences in their efficacy. Conclusion Overall the clinical trials were not of sufficient quality to accurately guide clinicians in the management of aggression and agitation post-TBI. The review identifies some evidence of efficacy of antipsychotic medication group in this patient population.

Droperidol for the treatment of acute migraine headaches.

To evaluate the safety and efficacy of droperidol for the relief of acute migraine headaches. A MEDLINE search (1946 to August 2014) was performed using the following keywords and associated medical subject headings: droperidol, inapsine, headache, migraine, and migraine disorder. The search was conducted to identify randomized controlled trials comparing droperidol with placebo or an active control in adult patients with acute migraine headaches that were published in English. Primary end points included acute headache improvement after the intervention. Safety end points included the frequency of extrapyramidal symptoms, somnolence, and cardiac adverse effects. In all, 5 manuscripts are included in this review. Patients presenting to the emergency department with acute headache desire rapid pain relief, which was the primary objective in each of the evaluated studies. Droperidol was better than placebo and at least as effective as comparator drugs such as prochlorperazine, meperidine, or olanzapine using droperidol doses of 2.5 to 5 mg, given either intramuscularly (IM) or intravenously (IV). The most commonly reported adverse effects were extrapyramidal symptoms and sedation. Cardiac adverse effects were not reported in any of the studies; however, only 2 articles described using cardiac monitoring. Parenteral droperidol is an effective option for the treatment of acute migraine. The minimum effective dose is 2.5 mg given IM or IV. Clinicians must be aware of the risk for adverse events, select appropriate patients, perform EKG monitoring for patients at risk of QTc prolongation, and institute treatment if necessary.

Droperidol transiently prolongs the QT interval in children undergoing single ventricle palliation.

Historically, droperidol was commonly used for postoperative sedation of critically ill children. A FDA black box warning regarding its arrhythmogenic potential greatly reduced its use. We hypothesized that administration of neuroleptic dose droperidol during volatile anesthesia would transiently prolong the corrected QT interval (QTc) in patients undergoing single ventricle palliation. As part of a prospective study in children undergoing stage 2 or 3 single ventricle palliation, we recorded electrocardiograms preoperatively, after induction of volatile anesthesia, immediately after completion of 30 min intravenous infusion of 75 mcg/kg droperidol, and shortly after arrival in the cardiac intensive care unit. Mean absolute QT intervals and heart rate data were analyzed in a blinded fashion and the longest QT interval was determined. QT intervals were corrected for heart rate (QTc) with the Bazett and Friderici formulae. Any perioperative arrhythmias were recorded. Complete data were available for 62 patients. Volatile anesthesia was associated with significant prolongation of the QTc interval. Administration of droperidol after cardiopulmonary bypass was associated with further significant QTc prolongation. All QTc changes were transient and the postoperative QTc, while still prolonged relative to baseline, was significantly shorter than the QTc immediately postdroperidol. No episodes of Torsades de Pointes (TdP) or ventricular arrhythmias were observed. The administration of a neuroleptic dose of droperidol during volatile anesthesia in patients undergoing single ventricle palliation was associated with a significant prolongation of QTc, which was transient and did not result in TdP or other ventricular arrhythmias in our study population.

Comparison of Droperidol and Haloperidol for Use by Paramedics: Assessment of Safety and Effectiveness

Background. Since the 2001 “black box” warning on droperidol, its use in the prehospital setting has decreased substantially in favor of haloperidol. There are no studies comparing the prehospital use of either drug. The goal of this study was to compare QTc prolongation, adverse events, and effectiveness of droperidol and haloperidol among a cohort of agitated patients in the prehospital setting. Methods. In this institutional review board-approved before and after study, we collected data on 532 patients receiving haloperidol (n = 314) or droperidol (n = 218) between 2007 and 2010. We reviewed emergency department (ED) electrocardiograms when available (haloperidol, n = 78, 25%; droperidol, n = 178, 76%) for QTc length (in milliseconds), medical records for clinically relevant adverse events (defined a priori as systolic blood pressure (SBP) <90 mmHg, seizure, administration of anti-dysrhythmic medications, cardioversion or defibrillation, bag–valve–mask ventilation, intubation, cardiopulmonary arrest, and prehospital or in-hospital death). We also compared effectiveness of the medications, using administration of additional sedating medications within 30 minutes of ED arrival as a proxy for effectiveness. Results. The mean haloperidol dose was 7.9 mg (median 10 mg, range 4–20 mg). The mean droperidol dose was 2.9 mg (median 2.5 mg, range 1.25–10 mg.) Haloperidol was given IM in 289 cases (92%), and droperidol was given IM in 132 cases (61%); in all other cases, the medication was given IV. There was no statistically significant difference in median QTc after medication administration (haloperidol 447 ms, 95% CI: 440–454 ms; droperidol 454 ms, 95% CI: 450–457). There were no statistically significant differences in adverse events in the droperidol group as compared to the haloperidol group. One patient in the droperidol group with a history of congenital heart disease suffered a cardiopulmonary arrest and was resuscitated with neurologically intact survival. There was no significant difference in the use of additional sedating medications within 30 minutes of ED arrival after receiving droperidol (2.9%, 95% CI: −2.5–8.4%). Conclusions. In this cohort of agitated patients treated with haloperidol or droperidol in the prehospital setting, there was no significant difference found in QTc prolongation, adverse events, or need for repeat sedation between haloperidol and droperidol.