Use Of Droperidol Research Articles

Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings.

There is a considerable amount of practice variation in managing migraines in emergency settings, and evidence-based therapies are often not used first line. A peer-reviewed search of databases (MEDLINE, Embase, CENTRAL) was carried out to identify randomized and quasi-randomized controlled trials of interventions for acute pain relief in adults presenting with migraine to emergency settings. Where possible, data were pooled into meta-analyses. Two independent reviewers screened 831 titles and abstracts for eligibility. Three independent reviewers subsequently evaluated 120 full text articles for inclusion, of which 44 were included. Individual studies were then assigned a US Preventive Services Task Force quality rating. The GRADE scheme was used to assign a level of evidence and recommendation strength for each intervention. We strongly recommend the use of prochlorperazine based on a high level of evidence, lysine acetylsalicylic acid, metoclopramide and sumatriptan, based on a moderate level of evidence, and ketorolac, based on a low level of evidence. We weakly recommend the use of chlorpromazine based on a moderate level of evidence, and ergotamine, dihydroergotamine, lidocaine intranasal and meperidine, based on a low level of evidence. We found evidence to recommend strongly against the use of dexamethasone, based on a moderate level of evidence, and granisetron, haloperidol and trimethobenzamide based on a low level of evidence. Based on moderate-quality evidence, we recommend weakly against the use of acetaminophen and magnesium sulfate. Based on low-quality evidence, we recommend weakly against the use of diclofenac, droperidol, lidocaine intravenous, lysine clonixinate, morphine, propofol, sodium valproate and tramadol.

A Plea for the Cautious Use of Droperidol

A Plea for the Cautious Use of Droperidol

In Reply

I thank the Editor for the opportunity to respond to the comments put forth by Dr. Sosis regarding our article.1 We did not justify the use of droperidol at the Mayo Clinic based on minutes of an offsite Food and Drug Administration meeting. We actually performed a large retrospective safety study which was published in the journal Anesthesiology in 2007.2 Droperidol was added back to our formulary after that study. I noted that droperidol was frequently being used by my colleagues. We performed our second retrospective safety study to determine whether this behavior was safe. We found no evidence of polymorphic ventricular tachycardia (VT) associated with the use of this drug.As noted in our article, there were eight patients who died after droperidol administration. All of the eight patients who died were on palliative care and died of their disease. There were four patients with documented VT, but all four patients had previous cardiac conditions: two had preexisting internal cardiac defibrillators, three had episodes of VT before receiving droperidol, and another had preexisting hypertrophic obstructive cardiomyopathy and underwent a septal myectomy. None of the above-mentioned patients had a prolongation of the QT. The back box states “Cases of QT prolongation and/or torsade de pointes, some fatal, have been reported in patients receiving droperidol at doses at or below recommended doses. All patients should undergo a 12-lead electrocardiogram before administration of droperidol to determine whether a prolonged QT interval (i.e., QTc >440 ms for males or 450 ms for females) is present. Do not administer droperidol if there is a prolonged QT interval. Droperidol is contraindicated in patients with known or suspected QT prolongation, including patients with congenital long QT syndrome. Administer droperidol with extreme caution to patients who may be at risk for development of prolonged QT syndrome, are more than 65 yr old, abuse alcohol, or when used concomitantly with benzodiazepines, volatile anesthetics, and IV opiates. Electrocardiogram monitoring should be performed before treatment and continued for 2–3 h after completing treatment to monitor for arrhythmias.”3 Being on palliative care and having a history of VT are not on the black box. You are correct that a total of 523 patients had a documented QTc more than 440 ms in the medical record within 1 yr before receiving droperidol. Use of this drug in these patients is not consistent with the black box warning, but none of the patients had polymorphic VT.I certainly respect your views and I respect the desires of the Food and Drug Administration efforts to protect patients, but now we have two large safety studies that indicate the black box warning possibly should not apply to low-dose droperidol administration. Also, a recent quantitative system review of 25 trials of low-dose droperidol in 2,957 patients by Schaub et al.4 found that prophylactic doses of droperidol less than 1 mg were antiemetic and there were no reports of QT prolongation or cardiac arrhythmia. Droperidol is not a perfect drug. I tend to use it only when it is strongly indicated, because its administration can be associated with dysphoric mentation. As you may know, the Food and Drug Administration also placed a Drug Safety Communication on ondansetron in 2011.* There are a multitude of commonly used drugs, which prolong the rate-corrected QT electrocardiographic interval, including volatile anesthetics, muscle relaxants, other antiemetics, and some opioids. Should all these agents have black box warnings?I certainly agree that caution should always be used, but the current black box warnings are based mostly on case reports. Would it not be better to base these warnings on science? I realize that retrospective studies are not robust science, but they are better than no science.

Does Low-Dose Droperidol Increase the Risk of Polymorphic Ventricular Tachycardia or Death in the Surgical Patient?

Background: The Food and Drug Administration issued a black box warning regarding the use of droperidol and the potential for torsade de pointes. Methods: The primary objective of this retrospective study was to determine if low-dose (0.625 mg) droperidol administration was associated with episodes of torsade de pointes in the general surgical population during the 3-yr period following the reinstitution of droperidol to our institutional formulary. Results: The authors identified 20,122 surgical patients who received 35,536 doses of droperidol. These patients were cross-matched with an electrocardiogram database and an adverse outcome database. The charts of 858 patients were reviewed, including patients with documentation of prolonged QTc (>440 ms) from March 2007 to February 2011, polymorphic ventricular tachycardia (VT) within 48 h of receiving droperidol, or death within 7 days of receiving droperidol. Twelve surgical patients had VT (n = 4) or death (n = 8) documented within 48 h of droperidol administration. No patients developed polymorphic VT or death due to droperidol administration (n = 0). The eight patients that died were on palliative care. The four patients with documented VT had previous cardiac conditions: two had pre-existing implantable cardiac defibrillators, three had episodes of VT before receiving droperidol, and another had pre-existing hypertrophic obstructive cardiomyopathy.

Does Low-dose Droperidol Increase the Risk of Polymorphic Ventricular Tachycardia or Death in the Surgical Patient?

The Food and Drug Administration issued a black box warning regarding the use of droperidol and the potential for torsade de pointes. The primary objective of this retrospective study was to determine if low-dose (0.625 mg) droperidol administration was associated with episodes of torsade de pointes in the general surgical population during the 3-yr period following the reinstitution of droperidol to our institutional formulary. The authors identified 20,122 surgical patients who received 35,536 doses of droperidol. These patients were cross-matched with an electrocardiogram database and an adverse outcome database. The charts of 858 patients were reviewed, including patients with documentation of prolonged QTc (>440 ms) from March 2007 to February 2011, polymorphic ventricular tachycardia (VT) within 48 h of receiving droperidol, or death within 7 days of receiving droperidol. Twelve surgical patients had VT (n = 4) or death (n = 8) documented within 48 h of droperidol administration. No patients developed polymorphic VT or death due to droperidol administration (n = 0). The eight patients that died were on palliative care. The four patients with documented VT had previous cardiac conditions: two had pre-existing implantable cardiac defibrillators, three had episodes of VT before receiving droperidol, and another had pre-existing hypertrophic obstructive cardiomyopathy. The authors found 523 patients with a documented QTc >440 ms before receiving droperidol. No patients developed VT or death as a direct result of droperidol administration. Our evidence suggests that low-dose droperidol does not increase the incidence of polymorphic VT or death when used to treat postoperative nausea and vomiting in the surgical population.

Facteurs de risque de pose de sonde gastrique en chirurgie colorectale programmée, dans le cadre d’un programme de réhabilitation postopératoire : une analyse multivariée

ObjectiveNasogastric tube placement (NTP) is no more systematically recommended in patients scheduled for elective colorectal surgery but could be necessary in case of postoperative vomiting. The aim of this study was to determine independent risk factors for NTP after colorectal surgery. Patients and methodsWe performed an observational study including 290 patients scheduled for elective colorectal surgery included in an enhanced recovery programme: immunonutrition, thoracic epidural analgesia, antiemetic prophylaxis, respiratory physiotherapy, absence of NT and drainage, forced mobilization and oral nutrition. The main outcome was the occurrence of vomiting requiring NTP. Univariate analysis included: age, sex, BMI, American Society of Anesthesiologist Physical Status Classification System (ASA), duration of surgery, epidural analgesia, and mobilization, intraoperative fluid, temperature, laparotomy, use of droperidol, parenteral nutrition, stoma, diabetes, hypertension or coronary disease, COPD, type of surgery. A logistic regression was performed to determine independent risk factors of NTP. ResultsAmong the 290 patients included, 277 were analyzed. The incidence of NTP was 10.5% (95%CI [7.4–14.6%]). Univariate analysis documented BMI, low temperature in PACU (<35°C), ASA scores, duration of surgery and epidural analgesia, rectal and sigmoid resections, diabetes, transfusion, no use of droperidol, duration of mobilization, conversion to laparotomy. Three independent risk factors were associated with NTP: temperature in SSPI<35.5°C (OR: 14.49; IC95% [4.52–45.45], P<0.0001), BMI<21kg/m2 (8.40; [1.99–35.71], P=0.0038) and lack of postoperative droperidol administration (3.37 [1.02–11.39], P=0.04). ConclusionsAfter colorectal surgery tolerance to rapid oral feeding is impaired by denutrition and postoperative hypothermia. The combined used of postoperative droperidol should also be considered to avoid postoperative NTP.

Clinical Ambulatory Anesthesia

Northwestern University Feinberg School of Medicine, Chicago, Illinois. r-boyer@northwestern.eduEdited by Johan Raeder, M.D., Ph.D. New York, Cambridge University Press, 2010. Pages: 194. Price: $ 55.00.There have been a myriad of textbooks and manuscripts written about the practice of ambulatory anesthesia, both as a subspecialty and as a subset of a general anesthesia practice. Unfortunately some authors writing on the subject have had little actual practice experience in the subspecialty. Because currently most surgeries globally are performed on an outpatient basis, for both clinical and financial reasons, it is refreshing to review a text by an author whose clinical and academic focus is the subject of the matter.Johan Raeder serves as Professor in Anaesthesiology at the University of Oslo, and in addition clinically practices ambulatory and office-based anesthesia and trauma care at Ullevaal University Hospital in Oslo. His stated purpose in writing Clinical Ambulatory Anesthesia is to help equip anesthesia providers with valuable tools and practical insight, based on his 30 yr of clinical practice focused on ambulatory and office-based anesthesia in Norway. His intended audience is the postgraduate anesthesiologist as well as, in the United States, certified registered nurse anesthetists. Dr. Raeder's focus is sensible and pragmatic and the short (194 pages) text is basically meant to assist those clinically involved with the daily perioperative care of the ambulatory surgical patient.This is a not an exhaustive review of current controversies and differing opinions, but a well-researched, realistic review of the background and history of ambulatory anesthesia, its basic organization, practical pharmacology, preoperative patient preparation, anesthetic techniques, and postoperative care as well as his anesthesia “recipes” and vision of the future of the subspecialty.The procedure, patient selection, and preoperative patient preparation chapter is exceptionally thorough and the author's methodology regarding presurgical/postsurgical patient information gathering/distribution is excellent. His well-researched, reasonable approach to preanesthesia evaluation could also be applied to most inpatient surgical venues.The well-annotated pharmacology section clearly reflects the author's additional academic and research interest in anesthetic pharmacology and anesthetic depth monitoring. It is complete with excellent tables and graphs, which assist the reader's understanding of this sometimes complex subject.Most chapters of the book, with the exception of that dealing with clinical pharmacology, are written in an almost informal, conversational tone and represent the author's reasonable approach to preoperative, intraoperative, and postoperative anesthesia care.Notwithstanding, there are several current periprocedural anesthesia management conundrums, where the author's beliefs may differ from current suggested practice guidelines in United States. A case in point is the recommended routine “safe” use of droperidol for postoperative nausea and vomiting. Another example of this is his approach to perioperative management of patients with obstructive sleep apnea. In 2006, the American Society of Anesthesiologists published suggested practice guidelines for the perioperative management of patients with obstructive sleep apnea that are fairly more robust than his suggested management paradigm.Nonetheless, this is a very readable reference for the practitioner not particularly desiring extensive data, charts, statistics, or tables, but who is more interested in a practical review of current preoperative, intraoperative, and postoperative ambulatory anesthesia issues and the author's experienced opinion and treatment strategies garnered from his 30 yr of clinical experience practicing anesthesia in Norway.

Survey of methadone-drug interactions among patients of methadone maintenance treatment program in Taiwan

BackgroundAlthough methadone has been used for the maintenance treatment of opioid dependence for decades, it was not introduced in China or Taiwan until 2000s. Methadone-drug interactions (MDIs) have been shown to cause many adverse effects. However, such effects have not been scrutinized in the ethnic Chinese community.MethodsThe study was performed in two major hospitals in southern Taiwan. A total of 178 non-HIV patients aged ≥ 20 years who had participated in the Methadone Maintenance Treatment Program (MMTP) ≥ 1 month were recruited. An MDI is defined as concurrent use of drug(s) with methadone that may result in an increase or decrease of effectiveness and/or adverse effect of methadone. To determine the prevalence and clinical characteristics of MDIs, credible data sources, including the National Health Insurance (NHI) database, face-to-face interviews, medical records, and methadone computer databases, were linked for analysis. Socio-demographic and clinical factors associated with MDIs and co-medications were also examined.Results128 (72%) MMTP patients took at least one medication. Clinically significant MDIs included withdrawal symptoms, which were found among MMTP patients co-administered with buprenorphine or tramadol; severe QTc prolongation effect, which might be associated with use of haloperidol or droperidol; and additive CNS and respiratory depression, which could result from use of methadone in combination with chlorpromazine or thioridazine. Past amphetamine use, co-infection with hepatitis C, and a longer retention in the MMTP were associated with increased odds of co-medication. Among patients with co-medication use, significant correlates of MDIs included the male gender and length of co-medication in the MMTP.ConclusionsThe results demonstrate clinical evidence of significant MDIs among MMTP patients. Clinicians should check the past medical history of MMTP clients carefully before prescribing medicines. Because combinations of methadone with other psychotropic or opioid medications can affect treatment outcomes or precipitate withdrawal symptoms, clinicians should be cautious when prescribing these medications to MMTP patients and monitor the therapeutic effects and adverse drug reactions. Although it is difficult to interconnect medical data from different sources for the sake of privacy protection, the incumbent agency should develop pharmacovigilant measures to prevent the MDIs from occurring. Physicians are also advised to check more carefully on the medication history of their MMTP patients.

Droperidol Analgesia for Opioid-Tolerant Patients

Background Patients with acute and chronic pain syndromes such as migraine headache, fibromyalgia, and sickle cell disease represent a significant portion of emergency department (ED) visits. Certain patients may have tolerance to opioid analgesics and often require large doses and prolonged time in the ED to achieve satisfactory pain mitigation. Droperidol is a unique drug that has been successfully used not only as an analgesic adjuvant for the past 30 years, but also for treatment of nausea/vomiting, psychosis, agitation, sedation, and vertigo. Objectives In this review, we examine the evidence supporting the use of droperidol for analgesia, adverse side effects, and controversial United States (US) Food and Drug Administration (FDA) black box warning. Discussion Droperidol has myriad pharmacologic properties that may explain its efficacy as an analgesic, including: dopamine D2 antagonist, dose-dependent GABA agonist/antagonist, α2 adrenoreceptor agonist, serotonin antagonist, histamine antagonist, muscarinic and nicotinic cholinergic antagonist, anticholinesterase activity, sodium channel blockade similar to lidocaine, and μ opiate receptor potentiation. Conclusion Droperidol is an important adjuvant for patients who are tolerant to opioid analgesics. The FDA black box warning does not apply to doses below 2.5 mg.

Predicting patterns of droperidol use in postoperative nausea and vomiting: A Delphi study

Predicting patterns of droperidol use in postoperative nausea and vomiting: A Delphi study

Droperidol: past present and future

I am pleased to see that droperidol is to reappear amongst anaesthetists’ armamentarium; its loss was deeply felt [1]. Professor Sneyd discussed its antiemetic properties but only mentioned its original use in anaesthesia as a neuroleptic agent. In about 1970 the late Dr Peter Basket introduced me to the use of droperidol at a dose of 0.25–0.3 mg.kg−1. At this dose, marked alpha blocking effects were present and 500–1000 ml of colloid was required to restore blood pressure. At this dose, presumably derived from psychiatry, droperidol had the reputation of causing the sensation of ‘invisible chains’. The patient would lie serenely smiling for 6 h or more, but later questioning would reveal that they were in terrible pain or having terrible thoughts or worries. In my own practice, I gradually reduced the dose to 2.5 mg, and at this dose I could detect no clinical difference to a plain opioid plus N2O:O2 regimen. This dose resulted in smooth anaesthesia and good postoperative conditions (including day-cases). The neuroleptic technique was to administer then titrate an opioid, initially phenoperidine and later fentanyl. Top-ups were given to maintain the respiratory rate > 8 min−1. Accidental overdose was common; rates of three breaths.min−1 were not infrequently encountered. At that time ECG monitoring was rare; my department only owned one 8-cm ‘bouncing ball’ monitor and oxygen saturation monitoring relied on skin colour. The addition of 60% nitrous oxide rendered the patient anaesthetised without recall as long as the nitrous concentration was maintained and supplementary opioid given, using respiratory rate and pulse rate as a guide and patient movement as an imperative. Neuroleptanaesthesia was revelation in comparison to the standard O2:N2O:halothane combination, with rapid patient recovery and a clear head for the anaesthetist compared with working in an atmosphere of un-scavenged volatile anaesthetics. When ECG monitoring finally became routine I never detected changes related to the use of droperidol. Neuroleptanalgesia was eventually superseded by midazolam and patient controlled propofol sedation, but I found neuroleptanaesthesia difficult to replace after droperidol was withdrawn. With the advent of proper scavenging systems, sevoflurane and total intravenous anaesthesia I could replicate, if somewhat more expensively, the peri-operative conditions of neuroleptanaesthesia. Perhaps the time of neuroleptanaesthesia has passed in the affluent world but elsewhere it may still have a place.

Droperidol Use in Pediatric Emergency Department Patients

Droperidol is a controversial drug with multiple clinical applications. This report examines the use of droperidol in pediatric emergency department (ED) patients. An observational structured chart review was conducted of patients 21 years or younger receiving droperidol as part of their ED treatment. Over a 32-month period, 79 ED records were identified for review. Patients' ages ranged from 15 to 21 years with a mean age of 19.4 (T0.2) years. Indications for droperidol included agitation, 68 (86%); nausea/vomiting, 7 (9%); headache, 2 (3%); and other pain, 2 (3%). Droperidol was the initial therapy in 63 patients (80%) and the rescue medication in 16 (20%). In nonagitated patients, droperidol was 100% effective in controlling patient's symptoms, whereas in agitated patients, droperidol alone was 86.6% effective as a single agent. Within the agitated patients, 35 (51.5%) were positive for drugs, 15 (22.1%) were positive for drugs and alcohol, and 12 (17.6%) were positive for alcohol alone. All patients were placed on continuous cardiac monitoring immediately after administration of the drug and for the duration of their active ED visit. No cardiac arrhythmias were noted. Thirty-eight patients (48%) were discharged from the ED, 35 (44%) were transferred to the psychiatric crisis unit for evaluation, 5 (6%) were admitted, and in 1 patient with biliary colic, the disposition was not recorded. No admissions were for droperidol-associated complications. Droperidol is a safe and effective medication in the adolescent and young adult population.

Continuing use of droperidol in patient-controlled analgesia with morphine

Continuing use of droperidol in patient-controlled analgesia with morphine

Droperidol Use in Pediatrics

Introduction: Droperidol is an effective yet controversial drug with multiple emergency department (ED) applications. This report examines the use of droperidol in pediatric-aged patients. Methods: An observational structured chart review was conducted of patients 21 years of age or younger receiving droperidol as part of their treatment in an urban, full-service, general ED. Information abstracted included: patient age, date of service, presenting complaint, ED medications, indication for droperidol, droperidol dose, restraint use, response to medications, urine drug screen results, serum alcohol level, use of cardiac monitoring, presence of dysrhythmias, and disposition.

The Black Box Warning for Droperidol

Holy Redeemer Hospital and Medical Center, Meadowbrook, Pennsylvania. mitchelsosis@hotmail.comI read with interest the recent article and accompanying editorial regarding the black box warning on the package insert for droperidol.1,2Nuttall et al. 2indicate that droperidol is a safe, effective, and inexpensive antiemetic and that the black box warning on the package insert is not needed. In addition, they seem to believe that their use of droperidol is prevented by the presence of the boxed warning.2I was surprised that according to their study,2the use of droperidol completely stopped after the addition of the black box warning. In contrast, midazolam, succinylcholine, and ketorolac all have black box warnings and still appear to be widely used by anesthesiologists.3Furthermore, the presence of a black box warning on a medication's package insert is not the same as the withdrawal of a medication, so clinicians are still able to use it if they choose to.In view of the events surrounding the withdrawal of rofecoxib (Vioxx)4and other medications,5the US Food and Drug Administration should make every effort to protect patients from drugs that may be dangerous and to alert physicians of these dangers.At my institution, antiemetics other than droperidol seem to be adequate for the prevention or treatment of postoperative nausea and vomiting, so we are to able to get along without droperidol. Moreover, ondansetron is now available as a generic medication, so this alternative to droperidol should be cheaper.6Holy Redeemer Hospital and Medical Center, Meadowbrook, Pennsylvania. mitchelsosis@hotmail.com

The Black Box Warning for Droperidol

Mayo Clinic College of Medicine, Rochester, Minnesota. nuttall.gregory@mayo.eduI thank Doctor Sosis for his thoughtful comments and the journal Anesthesiology for the opportunity to respond. As noted in our article,1the black box warning on droperidol was based solely on case reports of torsade de pointes associated with droperidol use and the known pharmacologic effect of droperidol to prolong the QT interval. Our manuscript was an attempt to determine, through a retrospective study, the true incidence of torsade de pointes associated with droperidol administration in patients who received low-dose droperidol for prophylaxis and/or treatment of nausea and vomiting associated with anesthesia and surgery. We found the incidence of torsade de pointes to be extremely low. This, combined with the fact that droperidol is one of the few very effective rescue therapies for patients who develop nausea and vomiting postoperatively, led to our conclusion that “the Food and Drug Administration black box warning for low-dose droperidol is excessive and unnecessary.”Dr. Sosis was “surprised” that according to our study, the use of droperidol completely disappeared after insertion of the black box warning. We were not, because this is consistent with what we have observed in our colleagues’ behavior throughout many institutions and expressed at many national meetings. From Dr. Sosis’ comments, I can only assume that he and his institution have continued to use droperidol for their patients despite the black box warning. However, given the last paragraph of his letter, I suspect that this is not true and that he and his institution have also stopped using droperidol. Dr. Sosis is correct that there are black box warnings on midazolam (respiratory depression and arrest), succinylcholine (acute rhabdomyolysis with hyperkalemia), and ketamine (emergence phenomena), and yet anesthesiologists still use these drugs. Most of these black box warning complications are situations that anesthesiologists are comfortable preventing or treating or avoiding via patient selection.In contrast, the black box warning on droperidol mandates that a 12-lead electrocardiogram be performed before administration of droperidol. If the QTc is greater than 440 ms for males and 450 ms for females (QTc values seen in at least 10% of all adults), droperidol is not to be administered. Further, the patient must have electrocardiographic monitoring for 2–3 h after droperidol administration. Functionally, logistically, and practically, many anesthesiologists do not want to deal with these hassles. They also fear the litigation costs should they use droperidol without following the black box–required electrocardiographic monitoring and should the patient have an adverse outcome.The withdrawal of rofecoxib (Vioxx) and other medications demonstrates the importance of postmarketing or phase IV safety studies. The goal of our study was to perform a phase IV trial of droperidol. As such, we found droperidol to be a safe, effective, and inexpensive antiemetic.Mayo Clinic College of Medicine, Rochester, Minnesota. nuttall.gregory@mayo.edu

Use of Droperidol for Ambulatory Eye Surgery in a Patient with Huntington's Chorea

Use of Droperidol for Ambulatory Eye Surgery in a Patient with Huntington's Chorea

The use of droperidol before and after the Food and Drug Administration black box warning: a survey of the members of the Society of Ambulatory Anesthesia

Study Objective To determine the practice of members of the Society of Ambulatory Anesthesia (SAMBA) in the management of postoperative nausea and vomiting (PONV) before and after the Food and Drug Administration (FDA) black box warning on droperidol. Design Survey questionnaire. Setting The Society of Ambulatory Anesthesia. Measurements After institutional review board approval, a survey was posted on the SAMBA Web site from June 1, 2005, until October 30, 2005. Visitors of the Web site were invited to participate in the survey. The survey was designed to elicit information about the management of PONV, particularly the use of droperidol, before and after the FDA black box warning. Participants were also asked about reasons for not using droperidol in their current practice and whether they believed that the black box warning was justified. Main Results Two hundred ninety-five physicians of 1,179 eligible SAMBA members completed the survey for a 25% response rate. For PONV prophylaxis, the choice of droperidol as a first-line agent decreased from 47% to 5% after the black box warning appeared ( P < 0.0001). Similarly, for treatment of established PONV, the choice of droperidol decreased from 38% to 8% during this same period ( P < 0.0001). A total of 261 (92%) of responders did not believe that the black box warning was justified. Conclusions Although most surveyed practitioners believed that the FDA black box warning on droperidol is not justified, the use of this cost-effective agent has significantly declined.

Sufficiency of data for resuming use of low-dose droperidol

In a much-needed and comprehensive review of data regarding droperidol use and QT-interval prolongation, Jackson and colleagues[1][1] argued that serotonin type 3-receptor antagonists have not been proven safer than low-dose droperidol and called for further study to provide clarity. We agree that

The use of droperidol decreases postoperative nausea and vomiting after gynecological laparoscopy

We evaluated whether or not routine prophylaxis with 2.5 mg of droperidol would efficiently prevent postoperative nausea and vomiting (PONV). Fifty-two patients scheduled for elective gynecological laparoscopic surgery were eligible for this study. Anesthesia was induced using propofol, fentanyl, and vecuronium, and maintained with sevoflurane in nitrous oxide, fentanyl, and vecuronium. Patients were randomized to one of two groups: group 1 patients (n = 23) received 2.5 mg droperidol intravenously when the surgery was started, while group 2 patients (n = 29) did not receive any droperidol. At the conclusion of the surgery, the patient was extubated on satisfactory emergence from general anesthesia. Any episodes of nausea and vomiting, rescue medications, and adverse effects were recorded until the next morning after the surgery. There were no differences in the duration of anesthesia on surgery between the groups, but the total fentanyl dose in group 1 was higher than that in group 2. Episodes of nausea and vomiting and the need for metoclopramide in group 1 were lower than in group 2, though the total fentanyl dose in group 1 was higher than in group 2. There were no differences in the need for analgesics between the groups. The use of 2.5 mg droperidol safely decreased PONV after gynecological laparoscopy.