The effects of droperidol and ondansetron on dispersion of myocardial repolarization in children

Mehta, Disha; Sanatani, Shubhayan; Whyte, Simon

doi:10.1111/j.1460-9592.2010.03408.x

Cited by 40 publications

(16 citation statements)

References 29 publications

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“…10 Mehta et al conducted a study that was published in 2010 to compare the effects of droperidol and ondansetron on the QT interval in children. 11 One hundred and eight children undergoing elective outpatient surgery were randomized to receive droperidol at 20 mcg/kg, ondansetron at CABG = coronary artery bypass grafting; CAD = coronary artery disease; CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; F = female; HB = heart block; H/o = history of; ICD = implantable cardiac defibrillator; LVAD = left ventricular assist device; M = male; MVR = mitral valve repair; PVC = premature ventricular contraction; VT = ventricular tachycardia.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the study's findings, the authors concluded that droperidol and ondansetron are highly unlikely to increase the risk of torsades in healthy pediatric patients. 11 We identified a number of limitations with this retrospective safety study, including: the inability to capture brief episodes of polymorphic VT with a 12-lead electrocardiogram, correct diagnosis of the event, or technical issues with how the database extracted its data. To eliminate bias we relied on documented medical provider diagnoses.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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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.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. Conclusions: 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. POsTOperATiVe nausea and vomiting (pONV) results in an increased length of hospital stay and decreases patient satisfaction. Droperidol, is used as an antiemetic and for treatment of agitation and delirium in critically ill patients.1 Lowdose droperidol, in the dose range of 0.625-1.25 mg, has been used successfully by anesthesia providers for the treatment and prevention of pONV in millions of patients for over 30 yr. 2,3Droperidol acts centrally by antagonizing one of the pathways causing nausea and vomiting. 4 in December 2001, The U.s. Food and Drug Administration issued a black box warning for droperidol based on safety reports of adverse cardiac events believed to be associated with QTc prolongation and the development of torsades de pointes (Tdp), a form of polymorphic ventricular tachycardia (VT).3 Before issuing the warning, there was accumulating evidence of QT prolongation and risk for Tdp and the Food and Drug Administration was called upon to review 22 cases of QT prolongation or Tdp, including five deaths. 5 The droperidol package

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…[22][23][24][25][26][27][28][29] Other studies reported efficacy of the drug in pediatric surgical or oncology patients. [30][31][32][33][34][35][36][37][38][39] One of those studies reported mild, asymptomatic QT prolongations that remained within normal limits. 31 A literature search was performed for reports of ventricular arrhythmias, fatalities, or any type of toxicity thought to be related to ondansetron in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

Fatal Cardiac Arrest in 2 Children

Brenner¹,

Boucher²

2016

Pediatr Emer Care

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“…Die angewendete niedrigere Dosierung ist auch deshalb sinnvoll, weil nach Prophylaxe/Therapie mit Tropisetron, das selbst leichte QT-Verlängerungen induziert, eine pharmakodynamische Interaktion nicht sicher ausgeschlossen werden kann [9,25].…”

Section: Diskussionunclassified

“…5-HT 3 -Antagonisten eignen sich dazu nicht [14,19], und die Dexamethasongabe zu wiederholen, ist nicht sinnvoll [13]. Rescue-Medikamente sollen über andere Wirkmechanismen wie Dopamin-, Histamin-oder Neurokininrezeptoren agieren [22] [8,25,26]. Bemerkenswert ist außerdem die Tatsache, dass 5-HT 3 -Antagonisten in großem Ausmaß verabreicht werden, obwohl auch für sie schwerste Herzrhythmusstörungen beschrieben worden sind [7,24].…”

Section: Diskussionunclassified

„Low-dose“-Droperidol-Gabe bei Kindern

et al. 2012

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The effects of droperidol and ondansetron on dispersion of myocardial repolarization in children

Abstract: Droperidol and ondansetron, in therapeutic anti-emetic doses, produce equivalent, clinically insignificant QT prolongation and negligible Tp-e prolongation, suggesting that neither is torsadogenic in healthy children at these doses.

Cited by 40 publications

References 29 publications

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

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

Fatal Cardiac Arrest in 2 Children

„Low-dose“-Droperidol-Gabe bei Kindern

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