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

Hernández-Rodríguez, Luis; Bellolio, Fernanda; Cabrera, Daniel; Mattson, Alicia E.; Vanmeter, Derek; Grush, Andrew E.; Silva, Lucas Oliveira J. e

doi:10.1016/j.ajem.2021.12.039

Cited by 5 publications

(7 citation statements)

References 43 publications

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“…A modest mean QTc increase of 30 ms was observed, with only 4.4% of patients experiencing an increase of ≥60 ms. While the findings of this study are reassuring, only two of the 68 patients were under 18 years old; thus the results may not be generalizable to children 29 …”

Section: Discussioncontrasting

confidence: 53%

“…While the findings of this study are reassuring, only two of the 68 patients were under 18 years old; thus the results may not be generalizable to children. 29 The most common adverse events described in the included articles after droperidol administration were hypotension (which typically did not require intervention) and dystonic reactions (which responded to anticholinergic medications). One case of respiratory depression occurred in a patient who also had alcohol intoxication.…”

Section: Discussionmentioning

confidence: 99%

“…While the findings of this study are reassuring, only two of the 68 patients were under 18 years old; thus the results may not be generalizable to children. 29 …”

Section: Discussionmentioning

confidence: 99%

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A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings

Ramsden

Pergjika

Janssen

et al. 2022

Academic Emergency Medicine

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Objective: Agitation in children in acute care settings poses significant patient and staff safety concerns. While behavioral approaches are central to reducing agitation and oral medications are preferred, parenteral medications are used when necessary to promote safety. The goal of this systematic review was to evaluate the effectiveness and safety of an ultra-short-acting parenteral medication, droperidol, for the management of acute, severe agitation in children in acute care settings. Methods:A systematic review of randomized controlled trials, observational studies, and case series/reports examined the effectiveness and safety of parenteral droperidol for management of acute agitation in patients ≤21 years old in acute care settings.Effectiveness outcomes included time to sedation and need for a subsequent dose of medication. Safety outcomes were adverse effects such as QTc prolongation, hypotension, respiratory depression, and dystonic reactions. Results: A total of 431 unique articles were identified. Six articles met inclusion criteria: two in the prehospital setting, one in the emergency department, and three in the inpatient hospital setting. The articles included a prospective observational study, three retrospective observational studies, and two case reports. The largest study reported a median time to sedation of 14 min (interquartile range 10-20 min); other studies reported a time to sedation of 15 min or less. Across studies, 8%-22% | 1467 RAMSDEN Et Al. BACKG ROUND AND IMP ORTAN CE Acute agitation in children in the hospital setting poses a serious safety risk to patients and staff. In a national survey of pediatric How to cite this article: Ramsden SC, Pergjika A, Janssen AC, et al. A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings. Acad

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings

Ramsden

Pergjika

Janssen

et al. 2022

Academic Emergency Medicine

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“…Since then, multiple indirect studies demonstrated the absence of any significant adverse effects of droperidol on the QTc interval in doses typically used for the treatment of CHS. 40,137,141,142 Rural or smaller EDs, or those that are overcrowded, may experience difficulty in using either haloperidol or droperidol if there is a requirement for patients to be on cardiac monitors. However, GRACE-4 Writing Team consensus supported that current evidence dictates that cardiac monitoring is not required for administration of this medication at doses typically administered for CHS unless other risk factors are present.…”

Section: Haloperidol and Droperidolmentioning

confidence: 99%

“…Both have been implicated with causing QTc prolongation, which has led to a black box warning for their use. Since then, multiple indirect studies demonstrated the absence of any significant adverse effects of droperidol on the QTc interval in doses typically used for the treatment of CHS 40,137,141,142 …”

Section: Pico Question 368mentioning

confidence: 99%

Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE‐4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department

Borgundvaag,

Bellolio,

Miles

et al. 2024

Academic Emergency Medicine

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The fourth Society for Academic Emergency Medicine (SAEM) Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE‐4) is on the topic of the emergency department (ED) management of nonopioid use disorders and focuses on alcohol withdrawal syndrome (AWS), alcohol use disorder (AUD), and cannabinoid hyperemesis syndrome (CHS). The SAEM GRACE‐4 Writing Team, composed of emergency physicians and experts in addiction medicine and patients with lived experience, applied the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding six priority questions for adult ED patients with AWS, AUD, and CHS. The SAEM GRACE‐4 Writing Team reached the following recommendations: (1) in adult ED patients (over the age of 18) with moderate to severe AWS who are being admitted to hospital, we suggest using phenobarbital in addition to benzodiazepines compared to using benzodiazepines alone [low to very low certainty of evidence]; (2) in adult ED patients (over the age of 18) with AUD who desire alcohol cessation, we suggest a prescription for one anticraving medication [very low certainty of evidence]; (2a) in adult ED patients (over the age of 18) with AUD, we suggest naltrexone (compared to no prescription) to prevent return to heavy drinking [low certainty of evidence]; (2b) in adult ED patients (over the age of 18) with AUD and contraindications to naltrexone, we suggest acamprosate (compared to no prescription) to prevent return to heavy drinking and/or to reduce heavy drinking [low certainty of evidence]; (2c) in adult ED patients (over the age of 18) with AUD, we suggest gabapentin (compared to no prescription) for the management of AUD to reduce heavy drinking days and improve alcohol withdrawal symptoms [very low certainty of evidence]; (3a) in adult ED patients (over the age of 18) presenting to the ED with CHS we suggest the use of haloperidol or droperidol (in addition to usual care/serotonin antagonists, e.g., ondansetron) to help with symptom management [very low certainty of evidence]; and (3b) in adult ED patients (over the age of 18) presenting to the ED with CHS, we also suggest offering the use of topical capsaicin (in addition to usual care/serotonin antagonists, e.g., ondansetron) to help with symptom management [very low certainty of evidence].

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Droperidol

2022

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

Cited by 5 publications

References 43 publications

A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings

A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings

Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE‐4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department

Droperidol

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