Rapid tranquilization of the agitated patient in the emergency department: A systematic review and network meta-analysis

deSouza, Ian S.; Thode, Henry C.; Shrestha, Pragati; Allen, Robert W.; Koos, Jessica; Singer, Adam J.

doi:10.1016/j.ajem.2021.11.011

Cited by 15 publications

(4 citation statements)

References 53 publications

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“…However, the overall 4.5% QTc prolongation rate in the D+M group is similar to prior reported rates. 6,23 In addition, de Souza et al 24 conducted a meta-analysis of 11 studies evaluating acute agitation therapies in the ED population and reported the D+M combination was likely to be the overall safest with regard to any adverse events compared with ketamine, olanzapine, ziprasidone, midazolam, H+L, lorazepam, haloperidol, and haloperidol + midazolam.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Droperidol and Midazolam Versus Haloperidol and Lorazepam for Acute Agitation Management in the Emergency Department

et al. 2023

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Background: Acute agitation accounts for up to 2.6% of visits to the emergency department (ED). To date, a standard of care for the management of acute agitation has not been established. Few studies have evaluated antipsychotic and benzodiazepine combinations. Objective: The purpose of this study was to evaluate effectiveness and safety of combination therapy for acute agitation with intramuscular (IM) droperidol and midazolam (D+M) compared with IM haloperidol and lorazepam (H+L) in patients in the ED. Methods: This was a single-center, retrospective medical record review of patients presenting to a large, academic ED with acute agitation from July 2020 through October 2021. The primary outcome was percentage of patients requiring additional agitation medication within 60 minutes of combination administration. Secondary outcomes included average time to repeat dose administration and average number of repeat doses required before ED discharge. Results: A total of 306 patients were included for analysis: 102 in the D+M group and 204 in the H+L group. Repeat dose within 60 minutes occurred in 7 (6.9%) and 28 (13.8%) patients in the D+M and H+L groups, respectively ( P = 0.065). A total of 28.4% of D+M patients and 30.9% of H+L patients required any repeat dose during their ED visit. Time to repeat dose was 12 and 24 minutes in the D+M and H+L, respectively ( P = 0.22). The adverse event rate was 2.9% in each group. Conclusion and Relevance: IM D+M resulted in a lower rate of repeat doses of acute agitation medication compared with IM H+L, though this was not statistically significant. Both therapies were safe, and the adverse event rate was low.

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Section: Discussionmentioning

confidence: 99%

Comparison of Droperidol and Midazolam Versus Haloperidol and Lorazepam for Acute Agitation Management in the Emergency Department

et al. 2023

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“…Long-term use of ketamine can cause significant ventricular myocardial apoptosis, fibrosis, and sympathetic denervation, leading to arrhythmias. An increase in liver enzymes has been observed with repeated use of ketamine in chronic pain [123,124]. Finally, other problems caused by chronic administration of ketamine include severe abdominal pain, dilatation of the bile ducts and bilateral corneal edema [125,126].…”

Section: Adverse Effects and Interactions Of Ketaminementioning

confidence: 99%

Ketamine, an Old–New Drug: Uses and Abuses

Savić Vujović,

Jotić,

Medić

et al. 2023

Preprint

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Ketamine as an old - new drug has variety of clinical implications. In the last 30 years, ketamine has become popular for acute use in humans. Ketamine at standard doses is principally utilized for the induction and maintenance in surgical procedures. Beside its use in anesthesia and analgesia, recently studies had shown that ketamine find the place in the treatment of asthma, epilepsy, depression, bipolar affective disorders, alcohol and heroin addiction. Its mechanism of action is complex, but it mostly acts as a noncompetitive antagonist at the N-methyl-D-aspartate (NMDA) receptor. Ketamine is generally considered relatively secure and does not result in serious adverse effects when used at low doses and for short periods- Also, ketamine is known as a powerful psychostimulant. During the past decade, ketamine has been one of the commonly abused drug.

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“…Prolonged ketamine use can result in notable ventricular myocardial apoptosis, fibrosis, and sympathetic denervation, ultimately contributing to the development of cardiac arrhythmia [ 133 ]. An increase in liver enzymes has been observed with repeated use of ketamine in chronic pain [ 134 , 135 ]. Additional issues arising from the prolonged administration of ketamine involve intense abdominal pain, dilation of the bile ducts, and bilateral corneal edema [ 136 , 137 ] ( Table 2 ).…”

Section: Adverse Effects and Interactions Of Ketaminementioning

confidence: 99%

Ketamine, an Old–New Drug: Uses and Abuses

Savić Vujović,

Jotić,

Medić

et al. 2023

Pharmaceuticals

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Ketamine as an old–new drug has a variety of clinical implications. In the last 30 years, ketamine has become popular for acute use in humans. Ketamine in standard doses is principally utilized for the induction and maintenance of surgical procedures. Besides its use in anesthesia and analgesia, recent studies have shown that ketamine has found a place in the treatment of asthma, epilepsy, depression, bipolar affective disorders, alcohol and heroin addiction. Ketamine primarily functions as a noncompetitive antagonist targeting the N-methyl-D-aspartate (NMDA) receptor, but its mechanism of action is complex. It is generally regarded as safe, with low doses and short-term use typically not leading to significant adverse effects. Also, ketamine is known as a powerful psychostimulant. During the past decade, ketamine has been one of the commonly abused drugs.

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Rapid tranquilization of the agitated patient in the emergency department: A systematic review and network meta-analysis

Cited by 15 publications

References 53 publications

Comparison of Droperidol and Midazolam Versus Haloperidol and Lorazepam for Acute Agitation Management in the Emergency Department

Comparison of Droperidol and Midazolam Versus Haloperidol and Lorazepam for Acute Agitation Management in the Emergency Department

Ketamine, an Old–New Drug: Uses and Abuses

Ketamine, an Old–New Drug: Uses and Abuses

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