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Emergency medicine updates: Droperidol. Am J Emerg Med 2022; 53:180-184. [DOI: 10.1016/j.ajem.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/31/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022] Open
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Prospective real-time evaluation of the QTc interval variation after low-dose droperidol among emergency department patients. Am J Emerg Med 2022; 52:212-219. [PMID: 34959024 PMCID: PMC8761164 DOI: 10.1016/j.ajem.2021.12.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE 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. METHODS Prospective cohort study of patients aged ≥12 years of age who received low-dose droperidol (≤ 2.5 mg) 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 ≥ 500 ms after droperidol, delta ≥ +60 ms, and incidence of clinical adverse events. Patients were monitored up to 30 min after IV bolus and up to 46 min after infusion. RESULTS A total of 68 patients were included (mean age 42.1 years, 66.2% females). The median dose of droperidol was 1.875 mg (range 0.625 mg, 2.5 mg) 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 +29.9 ms (SD 15). A total of 12 patients (17.6%) experienced a QTc interval ≥ 500 ms during the observation period after droperidol, and 3 patients (4.4%) had a delta QTc ≥ +60 ms. 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. CONCLUSION The QTc interval slightly increased after droperidol administration, but these prolongations were brief, mostly below 500 msec and did not lead to serious arrhythmias. The yield of continuous cardiac monitoring in patients receiving low doses of droperidol is likely low.
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Cole JB, Lee SC, Martel ML, Smith SW, Biros MH, Miner JR. Respone to: "Limitations of Retrospective Chart Reviews to Determine Rare Events, and the Unknown Relative Risk of Droperidol". West J Emerg Med 2020; 22:396-397. [PMID: 33856329 PMCID: PMC7972375 DOI: 10.5811/westjem.2020.9.49870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jon B Cole
- University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota.,Minnesota Poison Control System, Minneapolis, Minnesota.,Hennepin Healthcare, Department of Emergency Medicine, Minneapolis, Minnesota
| | | | - Marc L Martel
- University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota.,Hennepin Healthcare, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Stephen W Smith
- University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota.,Hennepin Healthcare, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Michelle H Biros
- University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota
| | - James R Miner
- University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota.,Hennepin Healthcare, Department of Emergency Medicine, Minneapolis, Minnesota
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Mattson A, Friend K, Brown CS, Cabrera D. Reintegrating droperidol into emergency medicine practice. Am J Health Syst Pharm 2020; 77:1838-1845. [DOI: 10.1093/ajhp/zxaa271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Purpose
After a long period of low utilization, droperidol has become easier to obtain in the US market. This comprehensive review discusses the safety, indications, clinical efficacy, and dosing of droperidol for use in the emergency department (ED) setting.
Summary
In 2001 the US Food and Drug Administration (FDA) mandated a boxed warning in the labeling of droperidol after reports of QT interval prolongation associated with droperidol use. Since that time, it has been difficult to access droperidol in the United States; as a result, many practicing clinicians lack experience in its clinical use. Multiple studies have been conducted to assess the clinical efficacy and safety of droperidol use in ED patients. Results consistently show the safety of droperidol and its clinical efficacy when used as an analgesic, antiemetic, and sedative. Now that droperidol is more widely available for use in the US market, pharmacists and prescribers need to reliably translate safety and efficacy data compiled since 2001 to help ensure appropriate and effective use of the medication.
Conclusion
Droperidol is an effective and safe option for the treatment of acute agitation, migraine, nausea, and pain for patients in the ED setting. Healthcare professionals can adopt droperidol for use in clinical practice, and they should become familiar with how to dose and monitor droperidol for safe and effective use.
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Affiliation(s)
| | | | | | - Daniel Cabrera
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
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Affiliation(s)
- Jessica Mason
- Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, CA.
| | - Christopher B Colwell
- Zuckerberg San Francisco General Hospital and Trauma Center, and the Department of Emergency Medicine, UCSF School of Medicine, San Francisco, CA
| | - Andrew Grock
- Division of Emergency Medicine Greater Los Angeles VA Healthcare System, and the David Geffen School of Medicine at UCLA, Los Angeles, CA
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Early DS, Lightdale JR, Vargo JJ, Acosta RD, Chandrasekhara V, Chathadi KV, Evans JA, Fisher DA, Fonkalsrud L, Hwang JH, Khashab MA, Muthusamy VR, Pasha SF, Saltzman JR, Shergill AK, Cash BD, DeWitt JM. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc 2018; 87:327-337. [PMID: 29306520 DOI: 10.1016/j.gie.2017.07.018] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/13/2017] [Indexed: 02/08/2023]
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Perkins J, Ho JD, Vilke GM, DeMers G. American Academy of Emergency Medicine Position Statement: Safety of Droperidol Use in the Emergency Department. J Emerg Med 2015; 49:91-7. [DOI: 10.1016/j.jemermed.2014.12.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 12/21/2014] [Indexed: 11/25/2022]
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IS DEXMEDETOMIDINE A POOR SURROGATE TO PROPOFOL FOR PROCEDURAL SEDATION DURING ENDOSCOPIC RETROGRADE CHOLANGIO-PANCREATOGRAPHY (ERCP). ACTA ACUST UNITED AC 2013. [DOI: 10.14260/jemds/1437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Are 2 Drugs Better Than 1 for Acute Agitation? A Discussion on Black Box Warnings, Waiver of Informed Consent, and the Ethics of Enrolling Impaired Subjects in Clinical Trials. Ann Emerg Med 2013; 61:708-16. [DOI: 10.1016/j.annemergmed.2013.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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10
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Pharmacologic choices for procedural sedation. Int Anesthesiol Clin 2013; 51:43-61. [PMID: 23532127 DOI: 10.1097/aia.0b013e31828d58dc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vargo JJ, DeLegge MH, Feld AD, Gerstenberger PD, Kwo PY, Lightdale JR, Nuccio S, Rex DK, Schiller LR. Multisociety Sedation Curriculum for Gastrointestinal Endoscopy. Am J Gastroenterol 2012:ajg2012112. [PMID: 22613907 DOI: 10.1038/ajg.2012.112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- John J Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic Lerner College of Medicine, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark H DeLegge
- Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew D Feld
- Group Health Cooperative, Division of Gastroenterology, University of Washington, Seattle, Washington, USA
| | | | - Paul Y Kwo
- Liver Transplantation, Gastroenterology/Hepatology Division, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jenifer R Lightdale
- Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Nuccio
- Aurora St Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Douglas K Rex
- Indiana School of Medicine, Indiana University Hospital, Indianapolis, Indiana, USA
| | - Lawrence R Schiller
- Digestive Health Associates of Texas, Baylor University Medical Center, Dallas, Texas, USA
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Abstract
Endoscopic Retrograde Cholangiopancreatography is used for both diagnostic and therapeutic purposes. It is relatively more complex than routine endoscopies and requires adequate patient sedation. Furthermore the patients often have co-morbidities. This article provides an overview of various anaesthetic drugs and the type of anaesthesiological support.
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Affiliation(s)
- H Kapoor
- Department of Anaesthesiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.
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Chainaki IG, Manolaraki MM, Paspatis GA. Deep sedation for endoscopic retrograde cholangiopacreatography. World J Gastrointest Endosc 2011; 3:34-9. [PMID: 21403815 PMCID: PMC3055942 DOI: 10.4253/wjge.v3.i2.34] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 12/17/2010] [Accepted: 12/24/2010] [Indexed: 02/06/2023] Open
Abstract
Sedation and analgesia comprise an important element of unpleasant and often prolonged endoscopic retrograde cholangiopacreatography (ERCP), contributing, however, to better patient tolerance and compliance and to the reduction of injuries during the procedure due to inappropriate co-operation. Although most of the studies used a moderate level of sedation, the literature has revealed the superiority of deep sedation and general anesthesia in performing ERCP. The anesthesiologist’s presence is mandatory in these cases. A moderate sedation level for ERCP seems to be adequate for octogenarians. The sedative agent of choice for sedation in ERCP seems to be propofol due to its fast distribution and fast elimination time without a cumulative effect after infusion, resulting in shorter recovery time. Its therapeutic spectrum, however, is much narrower and therefore careful monitoring is much more demanding in order to differentiate between moderate, deep sedation and general anesthesia. Apart from conventional monitoring, capnography and Bispectral index or Narcotrend monitoring of the level of sedation seem to be useful in titrating sedatives in ERCP.
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Affiliation(s)
- Irene G Chainaki
- Irene G Chainaki, Maria M Manolaraki, Departments of Anesthesiology, Benizelion General Hospital, Heraklion, Crete 71409, Greece
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Benson ME, Byrne S, Brust DJ, Manning B, Pfau PR, Frick TJ, Reichelderfer M, Gopal DV. EUS and ERCP complication rates are not increased in elderly patients. Dig Dis Sci 2010; 55:3278-83. [PMID: 20186485 DOI: 10.1007/s10620-010-1152-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 02/03/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Further studies evaluating the safety of advanced endoscopic procedures in elderly patients are needed. AIM To evaluate the safety of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) in the elderly. METHODS The study population, consisting of 1,000 patients who underwent ERCP or EUS, was divided into two cohorts. The elderly cohort consisted of patients ≥ 75 years old. The nonelderly cohort consisted of patients <75 years old. The data collected included demographic information, type of procedure completed, procedure medication used, and endoscopic intervention performed. Complications included any event which occurred during the procedure or up to 1 month post procedure. RESULTS A total of 600 ERCPs and 400 EUS were included. The mean age of the elderly cohort was 80 years (range 75-95 years, n = 184) versus 54 years (range 13-74 years, n = 816) for the nonelderly cohort. The ERCP complication rate was 10.0% in the elderly versus 10.6% (P = 1.0) for the nonelderly. The EUS complication rate was 4.8% in the elderly versus 3.1% in the nonelderly (P = 0.49). The overall complication rates were identical at 7.6% (P = 1.0). Sedation doses were lower for the elderly cohort (P < 0.001). There was a higher rate of procedure bleeding in the elderly cohort (P = 0.016). CONCLUSION Advanced age is not a contraindication for advanced endoscopic procedures. There is no significant increase in the rate of overall procedure-related complications seen with either ERCP or EUS in elderly patients; however, elderly patients have a higher risk of bleeding. Less procedure-related sedation medication is required for elderly patients.
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Affiliation(s)
- Mark E Benson
- Section of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Medical School, 600 Highland Avenue, Madison, WI 53792-5124, USA.
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Lichtenstein DR, Jagannath S, Baron TH, Anderson MA, Banerjee S, Dominitz JA, Fanelli RD, Gan SI, Harrison ME, Ikenberry SO, Shen B, Stewart L, Khan K, Vargo JJ. Sedation and anesthesia in GI endoscopy. Gastrointest Endosc 2008; 68:815-26. [PMID: 18984096 DOI: 10.1016/j.gie.2008.09.029] [Citation(s) in RCA: 271] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 09/19/2008] [Indexed: 02/08/2023]
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Vargo JJ, Ahmad AS, Aslanian HR, Buscaglia JM, Das AM, Desilets DJ, Dunkin BJ, Inkster M, Jamidar PA, Kowalski TE, Marks JM, McHenry L, Mishra G, Petrini JL, Pfau PR, Savides TJ, Savides TA. Training in patient monitoring and sedation and analgesia. Gastrointest Endosc 2007; 66:7-10. [PMID: 17591466 DOI: 10.1016/j.gie.2007.02.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Byrne MF. "Wake me up before you go-go". Drug, 'wham', scope, then snooze. Can't we do better with conscious sedation for endoscopy? CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 20:767-9. [PMID: 17171194 PMCID: PMC2660832 DOI: 10.1155/2006/670754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Michael F Byrne
- Division of Gastroenterology, Vancouver General Hospital, University of British Columbia.
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Abstract
Serious adverse events are fortunately quite rare for procedural sedation. Current physiologic monitoring recommendations are therefore either based on "softer" outcomes, such as transient hypoxemia, or on expert opinion. Pulse oximetry and supplemental oxygen are recommended for the reduction of hypoxemia. Outcomes-based data for extended monitoring are just starting to emerge, and one of these technologies may become a recommended component of patient monitoring. With data on more than 150,000 patients published in the literature, propofol is the most studied sedative agent for gastrointestinal endoscopy. In this author's opinion, its safety and efficacy have been established.
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Affiliation(s)
- John J Vargo
- Section of Therapeutic and Hepatobiliary Endoscopy, Department of Gastroenterology and Hepatology, Desk A-30, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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