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Antipsychotics accelerate patient sedation

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9 October 2012

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Certain clinically used drug combinations are faster and more effective in sedating highly aggressive patients in emergency departments.

A new study is shedding light on the use of sedative drugs in hospitals and has proven certain clinically used drug combinations to be faster and more effective in sedating highly aggressive patients in the emergency department (ED).

In an Australian study detailed in the Annals of Emergency Medicine, researchers from Monash University, Austin Health, Royal Melbourne Hospital and St Vincent’s found when antipsychotic drugs droperidol or olanzapine were used in combination with midazolam, adequate sedation of severely agitated emergency patients was achieved faster and were less likely to require re-sedation.

Investigators Dr David Kong and Dr Esther Chan, from the Centre for Medicine Use and Safety, said although a wide range of drugs and drug combinations (including droperidol or olanzapine) were used in clinical settings to sedate very agitated patients, the clinical evidence to support the combinations was lacking.

“Agitation and aggression is frequently observed in patients admitted to the emergency department as a result of mental illness, drug and alcohol intoxication, or both," Dr Kong said.

“We have compared three commonly used drug regimens in order to evaluate their safety and efficacy for the sedation of acutely agitated patients.”

Researchers found antipsychotic drugs droperidol or olanzapine, in combination with midazolam, shortened the time to sedation by an average of four to five minutes. 

“Our findings provide important evidence about how patients with acute agitation in EDs could be optimally managed by clinicians utilising a combination of medications," Dr Kong said.

"More effective management of acute agitation could significantly reduce stress and maximise the safety of both the patients and health professionals in clinical settings."

The study involved 336 adult patients with acute agitation requiring intravenous sedation in three Australian EDs. 

Professor David Taylor from the Emergency Department at Austin Health said four to five minutes was a long time to wait for effective sedation of emergency patients with mental illness and/or intoxication.

“This drug combination is safe, fast and inexpensive and we found no negative effects,” Professor Taylor said.

“The findings underscore the need for rapid and lasting sedating regimens in the ED and are good news for emergency physicians who deal with agitation and aggression among their patients on a daily basis.”

The study was supported by the National Health and Medical Research Council and Australian Rotary’s Ian Scott Scholarship in Mental Health.