A controlled clinical trial of oral droperidol and droperidol plus diazepam for premedication in children

In 87 children aged 2-9 yr, oral droperidol and oral droperidol plus diazepam were compared as premedicants in a controlled double-blind clinical trial. Atropine was given orally to all the patients. Droperidol was well absorbed and produced good sedation, associated with a low incidence of vomiting after operation. Droperidol plus diazepam did not appear to offer any advantage over droperidol alone. Anxiety and extrapyramidal effects were not observed and may have been obviated by the addition of atropine. Droperidol syrup was noted to be more palatable than other oral premedicants in use.

[Clinical studies on analgesia in obstetrics using intravenous administration of droperidol and pethidin (author's transl)]

In 70 healthy women under labor, the clinical properties of the combination DHB (0,1 mg/kg) and Pethidin (0.4 mg/kg) was studied for analgesia purposes in obstetrics; on request, Pethidin was given repeatedly. The fallowing conclusions can be drawn from this study: 1. The recommended "analgesic mixture" of DHB and Pethidin i.v. in the above mentioned doses is usually without harm to mothers and fetuses or new born respectively. 2. The Pethidin dosage, used in this study, agrees with the doses, recommended in the literature (0,4 mg/kg/h). 3. There was no difference between I-para, II, III-para etc., as far as the Pethidin requirement are concerned. 4. The analgesic properties of the mixture, judged by using clinical criteria only, were not quite convincing. This may be due to an increase of the intensity of uterine contractions by the mixture itself.

Droperidol in acutely agitated patients. A double-blind placebo-controlled study

Forty-one acutely agitated patients received an i.v. injection of 4 ml of a double blind solution containing either 10 mg of droperidol or placebo. The need for further medication (5 mg of haloperidol after 3 minutes or individually adapted psychotropics after 30 minutes) was used as a parameter for the evaluation of the results. Three minutes after the injection, haloperidol was needed by only six out of 19 patients of the droperidol group, but by 19 patients of the control group. Thirty minutes after the first injection, further medication was needed by only four droperidol patients and 10 placebo patients. No side effects could be attributed to the double blind medication.

Administration of ketamine or Innovar by the microdrip technic: a double blind study

This study of 40 healthy adults undergoing elective gynecologic procedures was undertaken to evaluate the microdrip technic of administering ketamine or Innovar slowly to induce anesthesia and to supplement N2O anesthesia. All patients were managed by the same anesthetist and surgeons and received 10 mg of diazepam and 0.4 mg of atropine IM for premedication. After injection of 10 mg of diazepam, anesthesia was induced by infusions containing either ketamine (2 mg/ml) or Innovar (0.1 ml/ml), at an average rate of 10 ml/min. The infusions were assigned to the patients randomly and their nature was disguised from the staff. After tracheal intubation, ventilation was mechanically supported and anesthesia maintained with N2O-O2 (2:1), by drip at a rate adjusted to the patient's vital signs, and by intermitten injections of 3 to 6 mg of d-tubocurarine. Special forms coded to suit computer use were used to collect data during induction, maintenance, and recovery, and standard mathematical tests were used for analysis. Results showed that (a) ketamine effects could not be differentiated clinically from those of Innovar; (b) ketamine dosage could be reduced to 0.3 to 0.5 the recommended bolus dosage; (c) pulse rates and incidence of mental aberrations during induction or recovery were equal in both groups; (d) blood pressure showed a modest but significant increase (10% from basal values) until 20 minutes of tracheal intubation only in the ketamine group; (e) mean Pao2 determined 30 minutes after tracheal intubation was significantly higher in the ketamine group; (f) ketamine administration by the slow (20 mg/min) microdrip technic reduces the incidence of side effects.

Neuroleptanalgesia for awake pronation of surgical patients

Pronation of anesthetized patients may result in complications. Neuromuscular block increases the risk. To minimize the risk, the authors devised a technic of "awake pronation," evaluating its feasibility, in 11 consecutive patients in a 1-year period for 12 operations; all attempts were successful and without complicatons. Neuroleptanalgesia is achieved with droperidol and fentanyl, topical anesthesia of the upper airway is induced with lidocaine, awake intubation is performed orotracheally under direct vision, and pronation is accomplished with patient cooperation.

[Experience with combined use of neurolepsy and vasodilator substances in the treatment of patients with acute myocardial infarct]

On the basis of an examination of 412 patients with myocardial infarction the efficacy of a long-term employment (for 3--4 days) of a neuroleptic Droperidol and a vasodilator Curantyl was examined. Optimum dosages of the drug and its administration techniques were worked out with due account of the data of clinical and physiological observations and blood concentrations of Curantyl. The incidence of the pain syndrome, of extrasystolic arrhythmias, of cardiogenic shock and sudden ventricular fibrillation was shown to decrease under the effect of the treatment. Without affecting the haemodynamics of the general circulation, the employed combination of drugs improved the pulmonary circulation and produced a beneficial inotropic effect upon the right ventricular myocardium, thus causing a distinct improvement of microcirculation, normalizing the ratio of diameters of the arterioles and venules, increasing the level of the tissue blood flow, and significantly reducing the intravascular aggregation of the formed elements of the blood. A long-term combined employment of the drugs for a few early days of the disease clearly favoured a positive haemodynamics in an important part of the patients, as demonstrated by the data of electro- and vectorcardiography.

The magnitude and duration of respiratory depression produced by fentanyl and fentanyl plus droperidol in man

In 10 healthy male volunteers breathing 100% oxygen, we determined the effect of four intravenous dose levels of fentanyl (0.0015, 0.003, 0.006 and 0.009 mg/kg) and two of fentanyl plus droperidol (i.e., Innovar, 0.003 and 0.006 mg/kg of fentanyl with 2.5 mg of droperidol for each 0.05 mg of fentanyl) on PECO2 and the slope of the ventilatory response to imposed increases in PECO2. All doses of fentanyl and fentanyl plus droperidol depressed the slope and shifted the curve to the right. Depression was dose related and was maximum 5 minutes after administration. The slope returned to control by 2 hours postinjection even at the highest narcotic dose. However, the rightward shift of the CO2 response curve require 4 hours to return to control. Droperidol added to fentanyl did not increase or prolong the respiratory depression seen with fentanyl alone at equivalent dose levels. Nausea and emesis occurred more frequently with fentanyl alone and orthostatic hypotension occurred more frequently with droperidol plus fentanyl. Dysphoria was a prominent consequence of fentanyl plus droperidol administration.

[Experience with the use of viadril anesthesia]

Based on experimental and clinical findings the authors concluded that a combination of viadril with neuroleptanalgesics shows a number of advantages over purely viadril anesthesia or its combination with other drugs for inhalation and intravenous anesthesia. The technic of thalmonal-viadril anesthesia is reported.

[Use of neruoleptoanalgesia in the postoperative period]

The authors recommend a postoperative administration of the mixture consisting of phentanil, droperidol and dimedrol. The mixture would provide anesthesia during 4-10 hours and a peaceful sleep during 2-4 hours. In case of necessity the mixture may be reinjected.

Effects of droperidol in management of vestibular disorders

The chemo-therapy of vestibular disease has involved a wide spectrum of pharmacological agents insofar as their mode of action is concerned. In our experience, however, droperidol is one pharmaceutical agent which is remarkably effective in depressing vestibular disturbance regardless of etiology. This medication (also called Inapsine) belongs to a relatively new class of compounds known as butyrophenones and its pharmacological action can best be described as a dopa blocking agent. The activity of droperidol on the nervous system first became evident when it was used in combination with the potent analgesic fentanyl citrate in order to produce an anesthetic condition that has been termed neuroleptanalgesia. This mixture (also called Innovar) is rapid in action and results in complete suppression of vestibular activity of both normal subjects and those with Ménière's disease as described by Dowdy, et al., in a preliminary report. These impressive results have prompted us to evaluate the effectiveness of this medication in the treatment of different disorders of the labyrinth. The patients chosen for evaluation were referred for vestibular examination at the Toronto General and St. Michael's Hospitals. Electronystagmography was used to record objectively the effects of the drugs being tested while subjective symptoms including side effects were also noted. These studies involved 20 patients receiving Innovar while 12 patients were tested with Inapsine. Innovar administered in a single dose (droperidol 5 mg, fentanyl 0.1 mg) to patients undergoing acute episodes of vestibular disease (vestibular neuronitis and Ménière's disease) was found effective in the following symptoms and/or signs: nausea, vertigo, nystagmus, the positive past-pointing test and the Romberg test. Innovar appeared to be effective in the amelioration of vomiting although the population was too small to demonstrate statistical significance in this regard. The drug mixture appeared to have no effect on improving auditory acuity and had no significant effects on tinnitus. Adverse reactions to the drug combination were unusual, and, occurring in three patients, were mild as manifested by drowsiness. Since the above findings confirmed the marked effectiveness of the fentanyl-droperidol mixture in the management of vestibular disease, it was decided to determine the relative effectiveness of the droperidol component alone and this was determined by comparing the effectiveness of the drug with placebo in a double-blind study. Review of our findings involving this double-blind study indicates significant responses to Inapsine. This therapy clearly provided the statistically significant response (p less than 0.1, Fisher's Exact Test). This was particularly apparent at the 60-minute evaluation point. While some of the patients receiving Inapsine had recovered earlier, by 60 minutes none of the placebo patients but all of the Inapsine patients had recovered from the vestibular symptoms of Ménière's disease...

Chronotropic effects of droperidol

To study the mechanism of action by which droperidol exerts a negative chronotropic effect, 3 series of experiments were performed: a) on isolated right atria of rabbits, b) on the isolated vas deferens of guinea-pigs and c) by injecting the drug directly into the sinus node artery of anesthetized dogs. Isolated tissue results include: lack of cholinergic action or beta-adrenergic antagonism: a calcium ion flux interference could not be demonstrated. Alpha adrenergic antagonism of the drug (pA2) was ascertained in the vas deferens. Injections of droperidol in the sinus node artery caused a negative chrontropic effect proportional to the dose and arrest ensued with the largest dose followed by His escape rhythm. Droperidol could not inhibit isoproterenol or dopamine-induced tachycardia and showed similar negative chronotropism in vagotomized and atropinized dogs. Negative chronotropic effects of the drug appear to be caused by an exit blockade of sinus impulses.

Effects of combined use of droperidol with pentazocine and with fentanyl on pulmonary hemodynamics

The effects of droperidol combined with pentazocine and with fentanyl on the pulmonary hemodynamics were investigated in intact dogs anesthetized with urethanechloralose, and the results were compared with those of each analgesic alone. Mean pulmonary arterial pressure and pulmonary driving pressure remained almost unchanged after droperidol and pentazocine. Pulmonary vascular resistance decreased significantly, and pulmonary vascular compliance and its radium tended to increase. These results indicate that droperidol counteracts the vasoconstrictive action of pentazocine on the pulmonary hemodynamics. On the contrary, almost all the parameters of the pulmonary hemodynamics after droperidol and fentanyl changed to similar directions to those after fentanyl alone. Droperidol seemed not to modify but to exaggerate the pulmonary circulatory effects of fentanyl.

Dysrhythmias associated with oral surgery

Seventy-eight fit adult patients undergoing minor oral surgery received one of three intravenous premedications or were unpremedicated. Cardiac rhythm was monitored during surgery. A significantly higher incidence of dysrhythmias was associated with intravenous atropine 0-3 mg/given prior to surgery. Droperidol 0-1 mg/kg did not act prophylactically as an anti-dysthythmic agent in comparison with the control group. A further trial of eighteen cases suggested that atropine 0-6 mg intramuscularly followed by controlled ventilation may be effective in preventing dysrhythmias.

Effects of fentanyl and droperidol on the dopamine metabolism of the rat striatum

Fentanyl in low doses (0.02-0.05 mg/kg) had no significant effect on the dopamine turnover 20 min after intraperitoneal (i.p.) injection and raised the homovanillic acid (HVA) concentration in the rat striatum with a maximum at 60 min after i.p. injection. Higher doses (0.1-0.2 mg/kg)reduced the HVA content after 20 min and raised it after 60 min. Naloxone (1 mg/kg) given shortly (5min) after high doses of fentanyl (0.2 mg/kg) was able to eliminate the early (i.e., 20 min after i.p. injection) decrease and the late (i.e., 60 min after i.p. injection)increase of HVA content in the striatum. Naloxone (1mg/kg) alone slightly increased the HVA concentration, after 20 as well as after 60 min. Droperidol (3-12 mg/kg) and haloperidol (6-12 mg/kg) markedly increased the HVA content in the rat striatum 90 min after i.p. injection. These effects were dose-dependent. Naloxone (1 mg/kg) did not significantly inhibit the rise of HVA induced by droperidol.

[The effects of neuroleptanalgesia on the sympathetic activity and the circulation in animals (author's transl)]

The effects of i.v. injected Fentanyl and droperidol used either singly or in combination were observed in 50 experiments carried out on cats which had been relaxed and artificially respirated. The preganglionic discharges of the cervical sympathetic nerve and action potentials of the phrenic nerve, the mean arterial pressure and the heart rate were recorded. The experiments showed that with the dosage of 0.0042-0.0083 mg/kg Fentanyl no significant change in the recorded functions took place. The dosage of 0.0166 mg/kg Fentanyl led to an activation of the central sympathetic activity and to a inhibition of the respiratory centre which persisted for as long as 60 min after the injections. Other than as above, a dosage of 0.15-0.6 mg/kg droperidol led to a decrease of the blood pressure and a depression of the sympathetic nerve activity, while the activity of the phrenic nerve remained unchanged. The effect on the blood pressure was mainly influenced by the central nervous system as the inhibition of the pressor effect of noradrenaline was only minimally. The dosage of 0.0083 mg/kg Fentanyl combined with 0.3 mg/kg dropendol as administered for neuroleptanalgesia led to a decrease in blood pressure and a depression of the central sympathetic and phrenic nerve activity both in rest and in stress during asphyxia. The effects were minimal and accorded virtually to the effects produced by 0.5 vol-% Halothane during the first 25 min of inhalation, which had been registered in previous experiments. Contrary to the effects of Halothane, neuroleptanalgesia produced no decrease in the heart rate, no depression on the pressor effects of noradrenaline and no accumulation of irregularities in cardiac rhythm after administration of noradrenaline.

Innovar as a preoperative medication

Innovar, administered intramuscularly 45 minutes preoperatively, provides excellent operative sedation, analgesia, and patient cooperation. Postoperative complications are minimized, and the quantity of postoperative analgesics and antiemetics is drastically reduced when Innovar is used as a preoperative medication.

[Sodium and water balance and renal function in volume expanded dogs under neuroleptanalgesia (author's transl)]

In 8 volume expanded dogs with an equilibrium between input and renal output of sodium and water neuroleptanalgesia of 6 hours duration with a total of 9 mg/kg of droperidol and 0.35 mg/kg of fentanyl was performed. Under anaesthesia GFR was increased by about 10% (p less than 0,02) compared with the conscious state, whilst renal sodium and water excretion was reduced by about 50%. From this we conclude that active tubular transport of sodium is augmented under neuroleptanalgesia. Due to decreased excretion, retention of sodium and water increased during anaesthesia changes of functional ECFV tending into the same direction. Plasma volume and intravascular protein did not change under neuroleptanalgesia compared with the conscious state. Urine osmolality and negative free water clearance (TcH2O) increased by about 60% under droperidol and fentanyl. In volume expanded dogs under neuroleptanalgesia intravenous application of 0.5-1.0 mg of atropine resulted in a temporary water diuresis.

[Advantages of the initial therapy of acute schizophrenia with large doses of droperidol/A comparative study (author's transl)]

The treatment of acute schizophrenic disorders with large doses of droperidol was compared to clozapine and clopenthixol in a special study. Apart from the clinical protocol, psychometric test for the assessment of social behaviour and thought disorders were used. The advantages of the treatment with droperidol, especially in highly disturbed acute schizophrenic patients, are shown and discussed by means of the results of psychological tests and clinical experience.

Anesthesia of marmots with sodium pentobarbital, ketamine hydrochloride, and a combination of droperidol and fentanyl

Three different anesthetics were tried on wild marmots to immobilize them sufficiently for intra-oral physiologic measurements and dental examination. Essentially the same procedure was performed or attempted on 15 animals. The droperidol (20 mg/ml) and fentanyl (0.4 mg/ml) combination gave better results than sodium pentobarbital or ketamine hydrochloride and was therefore used in most instances. We concluded that the dose rate should be adjusted to the nutritional state of the animal as well as to the absolute weight.