David McD Taylor1, Celene Y L Yap2, Jonathan C Knott3, Simone E Taylor4, Georgina A Phillips5, Jonathan Karro5, Esther W Chan6, David C M Kong2, David J Castle7. 1. Emergency Department, Austin Health, Heidelberg, Victoria, Australia. Electronic address: david.taylor@austin.org.au. 2. Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia. 3. Emergency Department, Royal Melbourne Hospital, Parkville, Victoria, Australia. 4. Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia. 5. Emergency Department, St Vincent's Hospital, Victoria Parade, Victoria, Australia. 6. Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong. 7. St Vincent's Hospital and the University of Melbourne, Fitzroy, Victoria, Australia.
Abstract
STUDY OBJECTIVE: We aim to determine the most efficacious of 3 common medication regimens for the sedation of acutely agitated emergency department (ED) patients. METHODS: We undertook a randomized, controlled, double-blind, triple-dummy, clinical trial in 2 metropolitan EDs between October 2014 and August 2015. Patients aged 18 to 65 years and requiring intravenous medication sedation for acute agitation were enrolled and randomized to an intravenous bolus of midazolam 5 mg-droperidol 5 mg, droperidol 10 mg, or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, droperidol 5 mg, or olanzapine 5 mg. The primary outcome was the proportion of patients adequately sedated at 10 minutes. RESULTS:Three hundred forty-nine patients were randomized to the 3 groups. Baseline characteristics were similar across the groups. Ten minutes after the first dose, significantly more patients in the midazolam-droperidol group were adequately sedated compared with the droperidol and olanzapine groups: differences in proportions 25.0% (95% confidence interval [CI] 12.0% to 38.1%) and 25.4% (95% CI 12.7% to 38.3%), respectively. For times to sedation, the differences in medians between the midazolam-droperidol group and the droperidol and olanzapine groups were 6 (95% CI 3 to 8) and 6 (95% CI 3 to 7) minutes, respectively. Patients in the midazolam-droperidol group required fewer additional doses or alternative drugs to achieve adequate sedation. The 3 groups' adverse event rates and lengths of stay did not differ. CONCLUSION:Midazolam-droperidol combination therapy is superior, in the doses studied, to either droperidol or olanzapine monotherapy for intravenous sedation of the acutely agitated ED patient.
RCT Entities:
STUDY OBJECTIVE: We aim to determine the most efficacious of 3 common medication regimens for the sedation of acutely agitated emergency department (ED) patients. METHODS: We undertook a randomized, controlled, double-blind, triple-dummy, clinical trial in 2 metropolitan EDs between October 2014 and August 2015. Patients aged 18 to 65 years and requiring intravenous medication sedation for acute agitation were enrolled and randomized to an intravenous bolus of midazolam 5 mg-droperidol 5 mg, droperidol 10 mg, or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, droperidol 5 mg, or olanzapine 5 mg. The primary outcome was the proportion of patients adequately sedated at 10 minutes. RESULTS: Three hundred forty-nine patients were randomized to the 3 groups. Baseline characteristics were similar across the groups. Ten minutes after the first dose, significantly more patients in the midazolam-droperidol group were adequately sedated compared with the droperidol and olanzapine groups: differences in proportions 25.0% (95% confidence interval [CI] 12.0% to 38.1%) and 25.4% (95% CI 12.7% to 38.3%), respectively. For times to sedation, the differences in medians between the midazolam-droperidol group and the droperidol and olanzapine groups were 6 (95% CI 3 to 8) and 6 (95% CI 3 to 7) minutes, respectively. Patients in the midazolam-droperidol group required fewer additional doses or alternative drugs to achieve adequate sedation. The 3 groups' adverse event rates and lengths of stay did not differ. CONCLUSION:Midazolam-droperidol combination therapy is superior, in the doses studied, to either droperidol or olanzapine monotherapy for intravenous sedation of the acutely agitated ED patient.
Authors: Luis Hernández-Rodríguez; Fernanda Bellolio; Daniel Cabrera; Alicia E Mattson; Derek VanMeter; Andrew E Grush; Lucas Oliveira J E Silva Journal: Am J Emerg Med Date: 2021-12-22 Impact factor: 2.469
Authors: Celene Y L Yap; Ya-Seng Arthur Hsueh; Jonathan C Knott; David McD Taylor; Esther W Chan; David C M Kong Journal: Pharmacoecon Open Date: 2018-06
Authors: Leonardo Baldaçara; Alexandre P Diaz; Verônica Leite; Lucas A Pereira; Roberto M Dos Santos; Vicente de P Gomes Júnior; Elie L B Calfat; Flávia Ismael; Cintia A M Périco; Deisy M Porto; Carlos E K Zacharias; Quirino Cordeiro; Antônio Geraldo da Silva; Teng C Tung Journal: Braz J Psychiatry Date: 2019-03-07 Impact factor: 2.697
Authors: Esther W Chan; Kim S J Lao; Lam Lam; Sik-Hon Tsui; Chun-Tat Lui; Chi-Pang Wong; Colin A Graham; Chi-Hung Cheng; Tong-Shun Chung; Hiu-Fung Lam; Soo-Moi Ting; Jonathan C Knott; David M Taylor; David C M Kong; Ling-Pong Leung; Ian C K Wong Journal: EClinicalMedicine Date: 2021-02-11