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Am J Emerg Med. 2016 Dec;34(12):2426-2431. doi: 10.1016/j.ajem.2016.09.025. Epub 2016 Sep 16.

Chemical agents for the sedation of agitated patients in the ED: a systematic review.

Author information

1
Royal Prince Alfred Hospital, Sydney, Australia.
2
NHMRC Clinical Trials Centre, University of Sydney.
3
Westmead Hospital, Sydney, Australia; Discipline of Emergency Medicine, Sydney Medical School, University of Sydney, New South Wales, Australia. Electronic address: naren.gunja@sydney.edu.au.

Abstract

OBJECTIVE:

Chemical agents commonly used to sedate agitated patients in the emergency department include benzodiazepines, antipsychotics, or a combination of the 2 classes. Our objective was to determine if a class or combination therapy is (1) more effective, as measured by the proportion sedated at 15-20 minutes and the need for repeat sedation, and (2) safer, as measured by the proportion of reported adverse events.

METHODS:

Systematic literature review and meta-analysis of studies comparing 2 or more chemical agents for sedation of agitated patients in the emergency department were carried out in PubMed, PsycINFO, Embase, and the Cochrane database. Meta-analyses for pairwise comparisons of drug class (benzodiazepine, antipsychotic, or combination) were carried out for each outcome: proportion sedated, need for repeat sedation, and adverse events.

RESULTS:

Seven studies with 1135 patients were included. At 15-20 minutes, the proportion of patients sedated was greater with combination therapy than benzodiazepines alone (risk ratio [RR] = 1.31, P < .0001). Antipsychotics and combination agents required significantly less repeat sedations than benzodiazepines alone (RR = 0.49, P < .0001 and RR = 0.64, P = .002). There was significant heterogeneity in adverse event data, with respiratory system adverse events (desaturation, and need for airway and ventilatory support) being the most commonly reported. Benzodiazepines were associated with a higher incidence of adverse events than antipsychotics or combination therapy.

CONCLUSION:

Combination therapy sedated a greater proportion of patients at 15-20 minutes than benzodiazepines alone. Antipsychotics and combination therapy were more effective, requiring less repeat doses for sedation than benzodiazepines. The risk of any adverse event was higher with benzodiazepines.

PMID:
27707527
DOI:
10.1016/j.ajem.2016.09.025
[Indexed for MEDLINE]

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