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Am J Emerg Med. 2013 Jun;31(6):970-3. doi: 10.1016/j.ajem.2013.03.026. Epub 2013 May 16.

Parenteral sedation of elderly patients with acute behavioral disturbance in the ED.

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  • 1Department of Clinical Toxicology and Pharmacology, Discipline of Clinical Pharmacology, University of Newcastle, Calvary Mater Newcastle, New South Wales, Australia.

Abstract

PURPOSES:

This study aimed to investigate sedation of elderly patients with acute behavioral disturbance (ABD) in the emergency department (ED), specifically the safety and effectiveness of droperidol.

BASIC PROCEDURES:

This was a prospective study of elderly patients (>65 years) with ABD requiring parenteral sedation and physical restraint in the ED. Patients were treated with a standardized sedation protocol that included droperidol. Drug administration, time to sedation, additional sedation, and adverse effects were recorded. Effective sedation was defined as a drop in the sedation assessment tool score by 2 or a score of zero or less.

MAIN FINDINGS:

There were 49 patients with median age of 81 years (range, 65-93 years); 33 were males. Thirty patients were given 10 mg droperidol, 15 were given 5 mg droperidol, 2 were given 2.5 mg, and 2 were given midazolam. Median time to sedation for patients receiving 10 mg droperidol was 30 minutes (interquartile range, 18-40 minutes), compared with 21 minutes (interquartile range, 10-55 minutes; P = .55) for patients receiving 5 mg droperidol. Three patients were not sedated within 120 minutes. Eighteen patients required additional sedation-10 of 30 (33%; 95% confidence interval, 18%-53%) given droperidol 10 mg compared with 7 of 15 (47%; 95% confidence interval, 22%-73%) given 5 mg. Fourteen patients required resedation. Adverse effects occurred in 5 patients (hypotension [2], oversedation [2], hypotension/oversedation [1])-2 of 30 given 10 mg droperidol and 3 of 19 not treated according to protocol. Midazolam was given initially or for additional sedation in 2 of 5 adverse effects. No patient had QT prolongation.

PRINCIPAL CONCLUSIONS:

Droperidol was effective for sedation in most elderly patients with ABD, and adverse effects were uncommon. An initial 5-mg dose appears prudent with the expectation that many will require another dose.

PMID:
23685060
DOI:
10.1016/j.ajem.2013.03.026
[PubMed - indexed for MEDLINE]
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