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

• Published in: The American journal of emergency medicine 2013-06, Vol.31 (6), p.970-973
• Main Authors: Calver, Leonie, Isbister, Geoffrey K., MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Airway management; Anesthesia; Behavior; Confidence intervals; Conscious Sedation - methods; Delirium; Droperidol - administration & dosage; Droperidol - adverse effects; Droperidol - therapeutic use; Drug dosages; Drug therapy; Duty of care; Emergency; Emergency medical care; Emergency Service, Hospital; Female; Heart attacks; Humans; Injections, Intramuscular; Male; Midazolam - administration & dosage; Midazolam - adverse effects; Midazolam - therapeutic use; Prospective Studies; Psychomotor Agitation - drug therapy; Restraint, Physical; SAT assessment; Side effects; Time Factors
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2013.03.026

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.