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In the journal Annals of Emergency Medicine, researchers report that when antipsychotic drugs droperidol or olanzapine were used in combination with midazolam, adequate sedation of severely agitated emergency patients was achieved faster and patients were less likely to require re-sedation.

Investigators David Kong and Esther Chan from the Center for Medicine Use and Safety at Monash University say 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,” Kong says.

“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 utilizing a combination of medications,” Kong says.

“More effective management of acute agitation could significantly reduce stress and maximize 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 emergency departments.

Professor David Taylor from the emergency department at Austin Health says 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,” Taylor says.

“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 National Health and Medical Research Council and Australian Rotary’s Ian Scott Scholarship in Mental Health supported the study, which was conducted by researchers from Monash University, Austin Health, Royal Melbourne Hospital, and St Vincent’s.

Source: Monash University