[Droperidol and dimenhydrinate alone or in combination for prevention of postoperative nausea and vomiting]

BACKGROUND

Droperidol and dimenhydrinate are inexpensive antiemetic drugs. Droperidol, especially, has been studied extensively in the past, but there are no studies that used the combination of both drugs for prevention of postoperative nausea and vomiting (PONV). Thus, the aim of this randomised controlled and double-blinded study was to evaluate the antiemetic efficacy and the side effects of such a combination therapy.

METHODS

240 inpatients undergoing ENT surgery under general anaesthesia were randomised to receive one of four antiemetic regimes: placebo, dimenhydrinate (1 mg x kg-1), droperidol (15 micrograms x kg-1), or the combination of both drugs (droperidol 15 micrograms x kg-1 + dimenhydrinate 1 mg x kg-1) was administered after induction of anaesthesia and repeated 6 hours after the first administration. For general anaesthesia a standardised technique including benzodiazepine premedication, propofol, desflurane in N2O/O2, vecuronium, and a continuous infusion of remifentanil was used. Postoperative analgesia and antiemetic rescue medication were standardised. Episodes of vomiting, retching, nausea, and the need for additional antiemetics were recorded for 24 hours. The main goal of the study was to increase the number of patients who were completely free from PONV (chi 2-test with Fisher-Yates' correction). Furthermore, the severity of PONV was analysed using a standardised scoring algorithm.

RESULTS

Data of 227 patients could be analysed. The incidence of patients who suffered from PONV was 41.3% (95%-confidence interval: 29-55%) in the placebo-group. Dimenhydrinate alone reduced PONV to 34.5% (95%-CI: 22-48%). This marginal effect and the effect of droperidol (PONV: 26.4% (95%-CI: 15-40%)) could not be proven statistically, since the power of the study was too small. The combination of both drugs decreased PONV to 19.6% (95%-CI: 10-32%) and also reduced the severity of the symptoms to a clinically acceptable level.

CONCLUSION

Dimenhydrinate failed to reduce the incidence and severity of PONV. The efficiency of droperidol given alone was within the ranges previously known from metaanalytic data. The combination of both drugs showed a moderate synergistic effect.

Small doses of propofol, droperidol, and metoclopramide for the prevention of postoperative nausea and vomiting after thyroidectomy

OBJECTIVE

To evaluate the efficacy and safety of small doses of propofol, droperidol, and metoclopramide for the prevention of postoperative nausea and vomiting (PONV) after thyroidectomy.

STUDY DESIGN

Prospective, randomized, double-blinded study.

SETTING

University-affiliated teaching hospital.

METHODS

In a randomized, double-blinded study, 90 patients (75 females) received propofol 0.5 mg/kg, droperidol 20 microg/kg, or metoclopramide 0.2 mg/kg intravenously (n = 30 in each group) at the end of surgery. A standardized general anesthetic technique was used.

RESULTS

The incidence of PONV during the first 24 hours after anesthesia was recorded in 13%, 47%, and 50% of patients who had received propofol, droperidol, and metoclopramide, respectively (P < 0.05; overall Fisher exact probability test). No clinically important adverse events were observed in any of the groups.

CONCLUSION

Small dose (0.5 mg/kg) of propofol is more effective than droperidol or metoclopramide for the prevention of PONV after thyroidectomy.

Effects of dopamine antagonists in human eye accommodation

The purpose of this study was to evaluate the effects of dopamine antagonists in accommodation of the human eye. The dopamine antagonist drugs used in this experiment include 0.5% metoclopramide and 0.25% droperidol. Eighteen healthy subjects were enrolled; they were randomly assigned, in double-masked fashion, to receive topical administration of a single drop of either 0.5% metoclopramide or 0.25% droperidol in one eye, with the fellow eye receiving isotonic saline as control. The accommodative abilities of both eyes were measured before instillation, and also at 3 and 6 hr after instillation of drugs, respectively. We studied the latency of reaction, the rate of accommodation, the average accommodative power, the rate of recovering and the total recovering time as the five parameters for evaluating the accommodative ability of each eye. The results showed that there were significant changes in two parameters: the rate of accommodation and rate of recovering, whereas there were no significant changes in the other three parameters: latency of accommodation, average power of accommodation and total recovering time. In conclusion, the dopamine antagonists may have some effects on the rate of accommodation but not the degree of accommodation. Further studies with higher concentrations of these dopamine antagonists on dose-response relationships are needed before exact drug efficacy can be drawn.

[Prevention of postoperative nausea and vomiting in gynecologic surgery with 3 fixed doses of metoclopramide, droperidol or placebo]

OBJECTIVES

To compare the efficacy and side effects of three doses of metoclopramide, droperidol or placebo administered every 8 h to prevent nausea and vomiting during the first 24 h after surgery.

MATERIAL AND METHODS

Prospective, double blind study of 104 patients scheduled for major intraabdominal gynecological surgery under general anesthesia. The patients were randomly assigned to three groups: group M received 10 mg of metoclopramide, group D received 1.25 mg of droperidol and group P received a saline solution. The patients were premedicated with oral diazepam. All patients were anesthetized using similar techniques, with fentanyl, thiopental, vecuronium, oxygen/nitrogen protoxide and isoflurane. Muscle relaxation was reversed with atropine and neostigmine. Postoperative analgesia was given with endovenous morphine and metamizol. Immediately after surgery each patient received an endovenous dose of the assigned antiemetic drug. Patients were monitored for 24 h and observations were recorded every hour on the following scale: 0, for no emetic symptoms, 1 for nausea and 2 for vomiting.

RESULTS

Fifteen patients (42.9%) in group D, 21 (60% in group M and 19 (54.3%) in group P experienced nausea during the 24 h after surgery, with no significant differences. However, the incidence of vomiting was significantly lower in group D, with 7 patients (20%) vomiting in group D versus 11 patients (31.43%) in group M and 17 (50%) in group P. Side effects were mild and required no treatment.

CONCLUSIONS

Droperidol at a dose of 1.25 mg every 8 h is effective and safe for preventing postoperative nausea and vomiting and has minimal side effects. Metoclopramide at a dose of 10 mg every 8 h, in our study, was no better for the same purpose than placebo.

Prevention of postoperative nausea and vomiting with antiemetics in patients undergoing middle ear surgery: comparison of a small dose of propofol with droperidol or metoclopramide

OBJECTIVE

To compare the efficacy and safety of a small dose of propofol with other commonly used antiemetics, droperidol and metoclopramide, for the prevention of postoperative nausea and vomiting in patients undergoing middle ear surgery.

DESIGN

Prospective, randomized, double-blind study.

SETTING

University-affiliated teaching hospital.

PATIENTS

Ninety patients (48 females, 42 males) scheduled for middle ear surgery.

INTERVENTION

Patients received propofol, 0.5 mg/kg, droperidol, 20 microg/kg, or metoclopramide hydrochloride, 0.2 mg/kg, intravenously at the end of the surgical procedure. A standardized general anesthetic technique was employed throughout the surgical procedure.

MAIN OUTCOME MEASURE

Emetic episodes and safety assessment were performed during 2 periods-0 to 3 hours in the postanesthetic care unit and 3 to 24 hours in the ward-after receiving anesthesia.

RESULTS

The incidence of patients who were emesis free during the 0- to 3-hour period after receiving anesthesia was 93% for those who received propofol, 73% for those who received droperidol, and 70% for those who received metoclopramide, respectively; the respective corresponding incidence during the 3- to 24-hour period after receiving anesthesia was 90%, 67%, and 60% (P<.05, overall Fisher exact probability test). No clinically adverse events were observed in any of the groups.

CONCLUSION

A small dose of propofol is a better antiemetic than droperidol or metoclopramide for the prevention of postoperative nausea and vomiting after middle ear surgery.

Droperidol and 5-HT3-receptor antagonists, alone or in combination, for prophylaxis of postoperative nausea and vomiting. A meta-analysis of randomised controlled trials

BACKGROUND

Droperidol and 5-HT3-receptor antagonists are among the most potent antiemetics to prevent postoperative nausea and vomiting (PONV). Combinations of these drugs have been used to increase the efficacy of antiemetic treatment. However, so far the quantitative effect of this combination has not been evaluated systematically.

METHODS

Results from randomised controlled trials investigating the efficacy of 5-HT3-receptor antagonists or droperidol alone versus the combination of both drugs to prevent PONV were included in a meta-analysis. Studies were systematically searched using Medline, EMBASE, the Cochrane-Library, and by manually screening the reference lists of matching review articles and current issues of locally available peer-reviewed anaesthesia journals. Seven papers with data on granisetron published by Fujii and co-workers were not considered. The main end point in each study was defined as occurrence of nausea, retching, or vomiting within 6 h ("early PONV") and within 48 h ("late PONV") after surgery. The relative risks (RR) and the numbers needed to treat (NNT) of the pooled data with their corresponding 95% confidence intervals (given in parentheses) were calculated using a random effects model.

RESULTS

Eight studies with 881 patients (adults: n=801; children (mean age: 8 yr): n=80) were included in the analysis. Droperidol was applied to 340 patients, 5-HT3-receptor antagonists to 198, and 343 were treated with a combination of both drugs. Seven out of these eight studies reported increased antiemetic efficacy of the combination group compared with the single drugs (droperidol and 5-HT3-receptor antagonists respectively). However, in none of the trials did this difference reach statistical significance. When a meta-analytic analysis based on these results was performed the combination of droperidol with a 5-HT3-receptor antagonist was not associated with a significantly increased antiemetic efficacy. In 12 to 13 patients a 5-HT3-receptor antagonist has to be added to droperidol prophylaxis to prevent one additional patient from PONV who would have had suffered from PONV when treated with droperidol alone (RR "early PONV": 1.52 (0.95-2.44); RR "late PONV": 1.24 (0.89-1.74)). Similar results were obtained when the antiemetic effect of adding droperidol to a prophylaxis with 5-HT3-receptor antagonists was analysed. In this case 10 to 12 patients have to be treated with the 5-HT3-droperidol combination instead of with a 5-HT3-receptor antagonist alone to prevent one additional patient from PONV (RR "early PONV": 1.55 (0.68-3.52); RR "late PONV": 1.29 (0.77-2.17)). There were no reports of an increased incidence of adverse effects.

CONCLUSION

The data on the combination of droperidol with 5-HT3-receptor antagonists suggest that there is a trend towards increased efficacy of the combination therapy compared to the single drugs. However, so far there are insufficient data to recommend this combination treatment for prophylaxis.

Small-dose droperidol effectively reduces nausea in a general surgical adult patient population

In this prospective, randomized, placebo-controlled study, we (1) determined whether 0.625 mg of IV droperidol given 30 min before emergence from general anesthesia reduces the incidence of immediate and delayed postoperative nausea and vomiting (PONV) in a general surgical adult patient population, and (2) compared the efficacy of droperidol, ondansetron, and promethazine for the rescue treatment of PONV. One hundred fifty adult patients receiving general anesthesia for >2 h received either droperidol (0.625 mg IV) or a placebo before emergence. Patients requiring treatment for PONV in the postanesthesia care unit were randomized to receive either droperidol (0.625 mg IV), ondansetron (4 mg IV), or promethazine (12. 5 mg IV). Droperidol effectively prevented PONV (6.8% in droperidol-treated patients versus 40.8% in placebo-treated patients, P: < 0.001). Droperidol, ondansetron, and promethazine were equally effective in treating established PONV, without significant differences in side effects or time to postanesthesia care unit discharge.

IMPLICATIONS

Droperidol 0.625 mg IV before emergence from general anesthesia effectively reduces postoperative nausea and vomiting (PONV) in the general surgical population. Our randomized, double-blinded, placebo-controlled study demonstrated a reduction in PONV from 41% to 7%. Droperidol is a safe and inexpensive alternative to ondansetron. Droperidol, ondansetron, and promethazine are also equally effective in treating PONV in the postanesthesia care unit.

[Extrapyramidal reactions after epidural droperidol]

We report two patients who developed extrapyramidal reactions after epidural droperidol given to prevent postoperative nausea and vomiting. The reactions may have been related to interactions of drugs given perioperatively. One patient had been taking amlodipine and amitriptyline preoperatively, capable of causing extrapyramidal reactions, and developed akathisia after 2.5 mg of droperidol given epidurally. The other patient had received 1.5 mg of prophylactic epidural droperidol and 10 mg of metoclopramide for postoperative nausea and vomiting, and developed acute dystonia shortly after 0.5 mg of intravenous droperidol.

Efficacy of prophylactic droperidol, ondansetron or both in the prevention of postoperative nausea and vomiting in major gynaecological surgery. A prospective, randomized, double-blind clinical trial

We conducted a prospective, randomized, double-blind clinical trial comparing droperidol 1.25 mg intravenously (i.v.) (group 1, n = 30), ondansetron 4 mg i.v. (group 2, n = 30), or both (group 3, n = 30) in the prevention of postoperative nausea and vomiting (PONV) in the first 24 h following major gynaecological procedures under combined general and epidural anaesthesia. PONV was analysed by a linear nausea/vomiting score, incidence of nausea and vomiting, and the need for antiemetic rescue. Our results showed a similar incidence of nausea and vomiting in all groups (G1 33%, G2 40%, G3 43%). However, when comparisons were made according to the time of assessment, combination therapy resulted in significantly lower PONV than droperidol in the first hour (0% vs. 13%, P < 0.05) and second hour (0% vs. 13%, P < 0.05), and than ondansetron on the first hour (0% vs. 13%, P < 0.05). A trend persisted up to the fourth hour but was not statistically significant in either group. In conclusion, droperidol and ondansetron are effective agents in the prevention of PONV, and their combination seems to provide slightly better results than either drug alone.

Routine droperidol pre-medication improves sedation for ERCP

BACKGROUND

Pre-medication with droperidol has been used to improve sedation during endoscopy, especially in patients with a history of alcohol or narcotic abuse. We studied whether routine use of droperidol pre-endoscopic retrograde cholangiopancreatography (ERCP) could improve patient and physician satisfaction with sedation.

METHODS

Sixty-seven patients undergoing routine ERCP were enrolled in this double-blind placebo-controlled study. Patients were given either parenteral normal saline solution or 5 mg of droperidol 15 minutes before the procedure. After the ERCP, several parameters of procedural sedation were scored on an ordinal scale by the endoscopist, the endoscopy nurse, and the recovered patient. In addition, a follow-up telephone call was made to the patient after 24 hours.

RESULTS

The mean procedural room time was similar in the two groups. Nearly 25% less meperidine and diazepam was used in the droperidol-treated patients, making the overall medication cost similar in both groups. The mean recovery room time was 113 minutes for the placebo group and 106 minutes for the droperidol group. Droperidol premedication significantly decreased post-procedure nausea and vomiting, reduced gagging at intubation, and decreased retching during the procedure. Droperidol also improved physician (p = 0.001), nurse (p = 0.001), and patient (p = 0.0001) impressions of overall sedation and decreased the need for physical restraint during the procedure. Droperidol significantly increased the number of patients with no memory of the procedure.

CONCLUSION

Droperidol improved overall patient, physician, and nurse satisfaction with sedation during ERCP. It also reduced post-ERCP nausea and vomiting without increasing recovery time or medication cost. Droperidol is recommended for routine pre-ERCP sedation. (Gastrointest Endosc 2000;52:362-6).

[Prevention of hemodynamic disorders during anesthesia in middle-aged and elderly patients with essential hypertension. Components of anesthesia. II]

Hemodynamic parameters were evaluated during various stages of anesthesia in two groups of patients aged 60-85 years with mild essential hypertension. In group 1, routine preoperative treatment with hypotensive drugs was carried out and in group 2 differentiated preoperative treatment with calcium antagonists was carried out with consideration for a hemodynamic type. Group I patients were operated on under traditional neuroleptic analgesia (NLA), group 2 under NLA with 40% lower drug doses than in group 1 and with addition of calcium antagonists. To patients with hypo- and eukinetic hemodynamics, nifedipine was injected (bolus injection) in a dose of 14.2 micrograms/kg before induction and then was infused in a dose of 6.0-14.2 micrograms/kg/min. Patients with hyperkinetic hemodynamics were injected verapamil in a dose of 70-140 micrograms/kg (bolus injection) and then the same dose every hour of the operation. Differentiated use of calcium antagonists during anesthesia helped transform the hyper- and hypokinetic types of hemodynamics into a more rational eukinetic type, which was associated with a decrease of MVO2. Calcium antagonists, exerting analgesic, automatic stabilizing, and antihypoxic effects, prevented the hyperdynamic reactions complicating NLA in 30% cases and precluded complications of concomitant ischemic diseases, which were observed in 40% of group 1 patients.

[Can postoperative nausea or vomiting be predicted?]

BACKGROUND

In order to identify patients who may benefit from prophylactic anti-emetic medication during surgery, it is of interest to evaluate risk factors for postoperative nausea and vomiting preoperatively by a simple scoring system.

MATERIAL AND METHODS

In this retrospective study we evaluated the ability to assess the risk of PONV by a preoperative clinical score developed in our institution (U-score, 0-13 points) and two simple scoring systems from the literature (A-score, 0-4 points and K-score, 0-5 points). 120 patients were interviewed 24 hours after a surgical procedure. Possible risk factors for PONV were scored and compared to the occurrence of PONV.

RESULTS

60% of patients experienced PONV during the first 24 postoperative hours. No difference was seen between those who had received droperidol prophylaxis and those who had not. A significant correlation (p < 0.01) were seen on all scoring systems between occurrence of PONV and high score. With the U-score, 78% of the patients with a score > 7 experienced PONV, compared to only 41% of those with a score < 6.

INTERPRETATION

We suggest that patients with a U-score > 7 should receive effective prophylaxis against PONV, i.e. not droperidol only. Further evaluation of different scoring systems should be carried out in larger patient populations. Simplified systems, such as the A-score or K-score or simplified U-score, may be sufficient in uniform surgical populations. The U-score may be more universal because anaesthetic method and use of postoperative opioids are also included.

Additive anti-emetic efficacy of prophylactic ondansetron with droperidol in out-patient gynecological laparoscopy

PURPOSE

To determine the efficacy of ondansetron and droperidol, alone and in combination, administered for prophylaxis of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for outpatient gynecological laparoscopy.

METHODS

Following Institutional Ethics Board approval and patient consent, 160 female out- patients scheduled for laparoscopy were randomly allotted in a double-blind fashion to receive: i) saline (placebo), ii) 4 mg ondansetron, iii) 1.25 mg droperidol, or iv) 4 mg ondansetron and 1.25 mg droperidol combination intravenously on induction. Following a standardized general anesthesia, patients were interviewed and assessed for PONV at various times.

RESULTS

During the first 24 hr after surgery, the incidence of PONV in the placebo group was 71%. This was reduced to 61% with droperidol alone (P = 0.334), to 46% with ondansetron alone (P = 0.027), and to 23% with the combination group (P<0.001). A statistically significant difference was observed between combination and droperidol (P<0.001) and between combination and ondansetron (P = 0.036). There were fewer requests for rescue medication from the combination group (7.7%) than from the ondansetron and placebo groups.

CONCLUSION

The results of this study suggest that the combination of 4 mg ondansetron and 1.25 mg droperidol is more efficacious as a prophylactic anti-emetic than either agent alone during the 24 hr post-surgery. This additive effect may be due to the different mechanisms of action of ondansetron and droperidol.

Oral induction of anesthesia with droperidol and transmucosal carfentanil citrate in chimpanzees (Pan troglodytes)

Five chimpanzees (Pan troglodytes) initially received oral droperidol sedation (1.25 mg for a juvenile chimpanzee, body wt = 18.5 kg, and 2.5 mg for adults, body wt >20 kg, range: 18.5-71 kg) followed by transmucosal carfentanil administration at 2.0 microg/kg. This preinduction regimen was developed to produce heavy sedation or even light anesthesia in order to eliminate the need for or at least minimize the stress of darting with tiletamine/zolazepam at 3 mg/kg i.m. This study was designed to assess the safety and efficacy of transmucosal carfentanil. Once each animal was unresponsive to external stimuli, or at approximately 25 min (range 24-34 min) after carfentanil administration, naltrexone and tiletamine/zolazepam (N/T/Z) were combined into one intramuscular injection for anesthetic induction. Naltrexone was administered at 100 times the carfentanil dose in milligrams. For comparison, two chimpanzees received only droperidol, 2.5 mg p.o., followed by tiletamine/zolazepam, 3 mg/kg i.m. The preinduction period for all animals receiving carfentanil was characterized as smooth, with chimpanzees becoming gradually less active and less responsive to external stimuli. Two animals became very heavily sedated at 24 and 35 min, respectively, and were hand injected with N/T/Z. The other three chimpanzees became sternally recumbent but retained some response to stimuli, and N/T/Z was administered by remote injection with minimal response. Rectal body temperatures, pulse and respiratory rates, arterial oxygen hemoglobin saturation, and arterial blood gases were measured at initial contact (t = 0 min) and at 10-min intervals thereafter. Respiratory depression was present in all chimpanzees, regardless of protocol. Mean hemoglobin saturation was 91% for both groups. Mean partial pressure of oxygen, arterial values for carfentanil-treated and control animals were 64.4 +/- 7.6 and 63.5 +/- 6.0 at t = 0, respectively. Only the partial pressure of carbon dioxide, arterial (Paco2) and pH showed significant differences between treated and control animals. Mean Paco2 was greater and mean pH lower for the carfentanil-treated group compared with the controls at t = 0 (58.9 +/- 3.7 and 50.3 +/- 3.1 for Paco2 and 7.33 +/- 0.02 and 7.40 +/- 0.30 for pH, respectively). The results of this study suggest that oral droperidol followed by transmucosal carfentanil can be used effectively as a premedication regimen to produce profound sedation, which limits the stress of darting during parenteral anesthetic induction with tiletamine/zolazepam in chimpanzees. The main side effect of respiratory depression appears to be adequately managed by reversing the carfentanil at the time of induction.

A comparison of commonly used anti-emetics for the prevention of emetic sequelae after a major gynaecological surgery

STUDY DESIGN

Prospective, randomized, double-blind, placebo-controlled study involving one hundred ASA I-II patients undergoing major gynaecological surgery.

OBJECTIVE

To study anti-emetic efficacy of intravenous (IV) ondansetron (4 mg), droperidol (2.5 mg), metoclopramide (10 mg), and placebo.

PATIENTS AND METHODS

100ASA physical status I-II undergoing major gynaecological surgery were randomized to receive intravenously (IV), one of the four test drugs 10 minutes before the end of anaesthesia. The incidence of postoperative nausea and vomiting following a standard anaesthetic technique was assessed.

RESULTS

A significantly large number of patients who received ondansetron (88%) and droperidol (72%) were free of emetic sequelae when compared to placebo (41%); p < 0.05 (power of this observation is approximately 80% at the given significance level). Metoclopramide was ineffective. Patients given droperidol were significantly more sedated than those receiving ondansetron; p < 0.05. This is not surprising, as the dose of droperidol used in this study was higher than that currently recommended because we found lower doses to be ineffective in controlling nausea and vomiting in this group of patients.

CONCLUSION

It was concluded that, of the drugs studied ondansetron is the best choice for anti-emetic prophylaxis after major gynaecological surgery.

The inhibition of epidural morphine-induced pruritus by epidural droperidol

IV droperidol inhibits epidural morphine-induced pruritus, but this effect disappears when the dose is increased from 2.5 to 5.0 mg. This study was performed to determine whether epidural droperidol would have a similar effect. In this double-blinded study, we enrolled 140 patients undergoing Cesarean delivery under epidural anesthesia who were randomly allocated to four groups. Anesthesia consisted of 150 mg of 0.5% bupivacaine with 1:200,000 epinephrine, with 2 mg of morphine and 0.0, 1.25, 2.5, or 5.0 mg of droperidol (Groups 1 to 4). During the postoperative period, patients were assessed for pruritus (absent, mild, moderate, or severe) and other untoward symptoms. The chi(2) test was used to compare the incidence of the side effects. For the analysis of pruritus, we used the Mantel-Haenszel test for linear association. Droperidol induced a dose-related reduction in the incidence of pruritus (P < 0.001). This reduction was independent of the incidence of somnolence, which increased with droperidol dose (P < 0.05 when the incidence of somnolence in Groups 1 and 4 was compared). We conclude that droperidol, in doses up to 5 mg epidurally, induces a dose-related reduction in the incidence of pruritus without inducing significant side effects.

IMPLICATIONS

Epidural morphine is effective for pain control but yields some side effects, including pruritus, that can be severe. Studying patients undergoing Cesarean delivery, we found a dose-related reduction in the incidence of pruritus using epidural droperidol.

Evaluating the usage of droperidol in acutely agitated persons with brain injury

The objective of this study was to compare the effectiveness and safety of intramuscular droperidol to other intramuscularly administered agents used in the management of acutely agitated patients. Twenty-seven inpatients with a history of brain injury were prospectively monitored over a period of 2 months. Data collected for each episode of agitation include: dose, number of doses, time to achieve an adequate response or calming effect, post-episodic functioning, treatment-emergent side effects, and other patient demographics. A retrospective medical records review was also performed on the same cohort, to compare clinical outcomes associated with other intramuscular agents previously used for acute agitation. Time to achieve calming was significantly shorter with intramuscular droperidol (mean = 27.0 minutes) compared to intramuscular haloperidol, lorazepam, or diphenhydramine (group mean = 36.2 minutes, p = 0.02). Of the three comparative agents, the time to achieve calming was the fastest with lorazepam (mean = 35.0 minutes), and slower with diphenhydramine (mean = 42.6 minutes) and haloperidol (mean = 43.0 minutes). Single doses of droperidol controlled agitation more frequently than did single doses of comparative agents, and there was less post-episodic sedation with droperidol following release from seclusion or restraints. Both groups were similar in regard to the incidence of treatment-emergent events. This data represents the first published experience supporting the effectiveness of droperidol in reducing acute agitation in persons with brain injury. Follow-up studies with prospective, double-blind, parallel treatment groups should be performed to validate these preliminary findings.

Small dose midazolam or droperidol reduces the hypnotic dose of propofol at the induction of anaesthesia

We investigated the effect of a small dose of midazolam, ketamine, droperidol or lidocaine on the propofol dose required for hypnosis during induction of general anaesthesia. These drugs were randomly administered to 100 patients about to undergo scheduled surgery. Propofol was then infused at a rate of 250 microg kg-1 min-1 and the hypnotic dose to produce hypnosis was evaluated. Midazolam (20 microg kg-1) and droperidol (20 microg kg-1) significantly reduced the mean hypnotic dose of propofol (mean) S.D.) compared with the placebo (43.7 +/- 17.8 mg, 61.9 +/- 10.6 mg and 72.5 +/- 27.7 mg after pretreatment with midazolam, droperidol and placebo, respectively), whereas ketamine (0.1 mg kg-1) and lidocaine (1 mg kg-1) did not significantly affect the hypnotic dose of propofol (63. 1 +/- 25.6 mg and 65.1 +/- 24.8 mg, respectively). Only midazolam when compared with saline administration, (176 +/- 66 s and 298 +/- 126 s, respectively), shortened the time to achieve hypnosis. The changes in blood pressure (non-invasive) and heart rate were not significantly different in all groups during the induction of anaesthesia and oro-tracheal intubation. These results raise the possibility that new combinations of central nervous system drugs, such as droperidol and propofol, have a potential to reduce the dose of intravenous anaesthetics, including propofol, that produce hypnosis without significant adverse effects.

Postoperative analgesia after arthroscopic knee surgery: a randomized, prospective, double-blind study of intravenous regional analgesia versus intra-articular analgesia

SUMMARY

The aim of this study was to determine the quality of postoperative analgesia in patients undergoing arthroscopic knee surgery using preoperative intravenous regional analgesia. After initial consultation with a statistician, we allocated 36 patients randomly and double-blind to 1 of 3 groups. Group A received intravenous regional analgesia preoperatively, group B received standard postperative intra-articular analgesia, and group C received saline and acted as the placebo. Our results showed no statistically significant difference in pain levels between the groups. However, there was a significantly larger amount of morphine administered by patient-controlled pumps in the placebo group when compared with the 2 treatment groups. There was no such difference between the 2 treatment groups. We concluded that preoperative regional analgesia in this setting is as good as but no better than intra-articular analgesia and that neither technique has any advantages over diclofenac plus patient-controlled analgesia.

Double-blind comparative study of droperidol, granisetron and granisetron plus dexamethasone as prophylactic anti-emetic therapy in patients undergoing abdominal, gynaecological, breast or otolaryngological surgery

In this double-blind study the clinical efficacy of a single pre-operative intravenous dose of droperidol 1.25 mg (137 patients), granisetron 1 mg (130 patients) and granisetron 1 mg plus dexamethasone 5 mg (130 patients) was investigated for the prevention of postoperative nausea and vomiting after gynaecological surgery, breast surgery, abdominal surgery and ear, nose and throat surgery. The incidence of nausea in the first 24 h postoperatively was 52% in the droperidol group, 48% in the granisetron group and 34% with the combination, respectively. Both granisetron and granisetron/dexamethasone performed better than droperidol in their effects on vomiting or combined nausea and vomiting (incidence in the first 24 h 22%, 18% and 42%, respectively). The number of emetic episodes during the 5-day study period was significantly higher in the droperidol group (198) than in the granisetron (73) or combination group (78).

Droperidol: efficacy and side effects in psychiatric emergencies

BACKGROUND

As admission criteria to inpatient units become more focused on patient safety and behavioral instability, primary treatment often requires use of medications that need to be quick, safe, and effective for control of agitation. This article reviews the evidence that droperidol may serve as the optimal medication for this task.

DATA SOURCES

A comprehensive MEDLINE search of English-language literature was conducted using the search term droperidol concerning the use of droperidol in psychiatric emergencies. Cross-referencing of those articles was conducted to include pertinent articles in the non-psychiatric and European literature regarding safety and early development of the drug.

STUDY FINDINGS

As evidenced in the animal and clinical literature, studies demonstrate the efficacy and rapidity of onset of droperidol and its relative safety compared with the most widely used antiagitation drug, haloperidol. Evidence for this use of droperidol is particularly compelling for situations in which intramuscular administration is necessary.

CONCLUSION

Droperidol, while not in widespread use, may prove to be the superior typical neuroleptic for psychiatric emergencies. Increased clinical utilization and study of droperidol for this use is warranted.

Prevention of post-operative nausea and vomiting with combined granisetron and droperidol in women undergoing thyroidectomy

We have compared the efficacy and safety of combined granisetron and droperidol with each anti-emetic alone for preventing post-operative nausea and vomiting after thyroidectomy. In a prospective, randomized, double-blind study, 180 women received granisetron 40 micrograms kg-1, droperidol 20 micrograms kg-1, or granisetron 40 micrograms kg-1 plus droperidol 20 micrograms kg-1 (n = 60 of each) intravenously immediately before induction of anaesthesia. A standard general anaesthetic technique and post-operative analgesia were used. A complete response, defined as no post-operative nausea and vomiting and no need for another rescue anti-emetic, during the first 24 h after anaesthesia occurred in 88%, 60% and 98% of patients who had received granisetron, droperidol and granisetron plus droperidol (P < 0.05; overall Fisher's exact probability test). No clinically important adverse events due to the drugs were observed in any of the groups. In summary, prophylactic use of combined granisetron and droperidol is more effective than each drug alone for the prevention of post-operative nausea and vomiting in female patients undergoing thyroidectomy.

The antiemetic and dysphoric effects of droperidol in the day surgery patient

The incidence of side-effects of two doses of droperidol used as a prophylactic antiemetic were compared (10 vs 20 micrograms/kg). Two hundred and twenty-eight women for day case laparoscopy were recruited. Pain and nausea scores were collected in the recovery area and in the Day Surgery Unit prior to discharge. A telephone follow-up questionnaire was administered. Incidences of anxiety, restlessness and dysphoric reactions were similar in both groups (29.2% vs 29.0%). The incidence of postoperative vomiting varied from 4.4 to 7.7%. There were no significant differences between the two groups when nausea scores, incidences of vomiting and pain after discharge were compared. An unexpected finding was the significantly higher incidence of pain in the 10 micrograms/kg group. We conclude that there is no advantage in lowering the dose of droperidol below 20 micrograms/kg in this group of patients.

A randomized double-blind placebo-controlled trial evaluating the cost-effectiveness of droperidol as a sedative premedication for EUS

BACKGROUND

Droperidol is a neuroleptic agent with anti-emetic properties that produces mild sedation, reduced anxiety, and a state of mental detachment and indifference to one's surroundings. Routine premedication with droperidol has been shown to improve sedation during esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography. The purpose of this randomized double-blind placebo-controlled study was to determine whether premedication with droperidol improves sedation during routine upper endoscopic ultrasound (EUS) in a cost-effective manner.

METHODS

One hundred consecutive patients referred for EUS were randomly assigned to receive either 2.5 mg or 5 mg of droperidol or placebo before the procedure. After EUS, the physician, nurse, and recovered patient scored various parameters of procedural sedation.

RESULTS

In the group receiving 5 mg of droperidol there was significantly less gagging at intubation, less retching during the procedure, better patient cooperation, less need for physical restraint, and improved nurses' and physician's impression of sedation. Significantly less meperidine and less midazolam were required for sedation, making medication costs significantly lower in the group receiving 5 mg droperidol.

CONCLUSIONS

A 5 mg dose of droperidol given as premedication for routine upper EUS improves sedation during the procedure while significantly decreasing the overall cost of sedation.