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Introduction: Droperidol carries a boxed warning from the United States Food and Drug Administration for QT prolongation and torsades des pointes (TdP). After a six-year hiatus, droperidol again became widely available in the US in early 2019. With its return, clinicians must again make decisions regarding the boxed warning. Thus, the objective of this study was to report the incidence of QT prolongation or TdP in patients receiving droperidol in the ED.Methods: Patients receiving droperidol at an urban Level I trauma center from 1997–2001 were identified via electronic health record query. All patients were reviewed for cardiac arrest. We reviewed electrocardiogram (ECG) data for both critically-ill and noncritical patients and recorded Bazett’s corrected QT intervals (QTc). ECGs from critically-ill patients undergoing resuscitation were further risk-stratified using the QT nomogram.Results: Of noncritical patients, 15,374 received 18,020 doses of droperidol; 2,431 had an ECG. In patients with ECGs before and after droperidol, the mean QTc was 424.3 milliseconds (ms) (95% confidence interval [CI], 419.7-428.9) before and 427.6 ms (95% CI, 424.3-430.9), after droperidol(n = 170). Regarding critically-ill patients, 1,172 received droperidol and 396 had an ECG. In the critically-ill group with ECGs before and after droperidol mean QTc was 435.7 ms (95% CI, 426.7–444.7) before and 435.8 ms (95% CI, 427.5–444.1) after droperidol (n = 114). Of 337 ECGs suitable for plotting on the QT nomogram, 13 (3.8%) were above the “at-risk” line; 3/136 (2.2%; 95% CI, 0.05-6.3%) in the before group, and 10/202 (4.9%; 95% CI, 2.4%-8.9%) in the after group. A single case of TdP occurred in a patient with multiple risk factors that did not reoccur after a droperidol rechallenge. Thus, the incidence of TdP was 1/16,546 (0.006%; 95% CI, 0.00015 - 0.03367%).Conclusion: We found the incidence of QTc prolongation and TdP in ED patients receiving droperidol to be extremely rare. Our data sugge

Background: Droperidol can be used parenterally to treat nausea and vomiting, migraine, and acute behavioral disturbance. Its rapid onset of action after parenteral administration make it ideal for use in the Emergency Department. Intranasal (IN) use is not reported for droperidol. Intranasal drug administration reduces need for IV placement and risk of needle-stick.We hypothesized that intranasal droperidol is well absorbed intranasally. Method(s): Open-label crossover volunteer study comparing pharmacokinetics of single dose IV and IN droperidol. Volunteers received 0.02 mg/ kg of droperidol (DORM, Phebra, Australia, 5 mg/ml) by each route with a 1-week washout period. Intranasal droperidol diluted to a standardized volume (0.5 ml/nare), administered with LMA MAD Nasal device (Wolfe-Tory Medical, Utah, USA). Clinical observations, sedation, and serial ECGs were recorded throughout the study period. Blood samples were collected over 10 h and batch analyzed by high-pressure liquid chromatography tandem mass spectrometry. Pharmacokinetic variables including peak concentration (Cmax), time to peak concentration (Tmax), elimination half-life, areaunder- the-curve (AUC) were calculated using non-compartmental analysis with EquivTestPK. Result(s): Seven male volunteers, median age 23 years (range 20-43), median weight 73 kg (range 65-98), median height 180 cm (range 170- 195) were included. Median Cmax IV was 26.6 ng/ml vs IN 6.5 ng/ml (p=0.0006) at median Tmax IV 0.25 h vs IN 0.5 h (p = 0.002). Elimination half-life was IV 2.02 h and IN 2.37 h. Mean AUC for IV was 41.4 ng.h/ml vs IN 19.2 ng.h/ml (p = 0.002) giving an intranasal bioavailability of 40 %. All subjects reported mild degrees of sedation/ drowsiness with onset consistent with the Tmax for both routes of administration. There were no adverse clinical effects or QT interval prolongation. Conclusion(s): Droperidol intranasal bioavailability was 40 %. The dose used in this study was small and diluted. Larger dose

Introduction: Droperidol carries a boxed warning from the United States Food and Drug Administration for QT prolongation and torsades des pointes (TdP). After a six-year hiatus, droperidol again became widely available in the US in early 2019. With its return, clinicians must again make decisions regarding the boxed warning. Thus, the objective of this study was to report the incidence of QT prolongation or TdP in patients receiving droperidol in the ED.Methods: Patients receiving droperidol at an urban Level I trauma center from 1997–2001 were identified via electronic health record query. All patients were reviewed for cardiac arrest. We reviewed electrocardiogram (ECG) data for both critically-ill and noncritical patients and recorded Bazett’s corrected QT intervals (QTc). ECGs from critically-ill patients undergoing resuscitation were further risk-stratified using the QT nomogram.Results: Of noncritical patients, 15,374 received 18,020 doses of droperidol; 2,431 had an ECG. In patients with ECGs before and after droperidol, the mean QTc was 424.3 milliseconds (ms) (95% confidence interval [CI], 419.7-428.9) before and 427.6 ms (95% CI, 424.3-430.9), after droperidol(n = 170). Regarding critically-ill patients, 1,172 received droperidol and 396 had an ECG. In the critically-ill group with ECGs before and after droperidol mean QTc was 435.7 ms (95% CI, 426.7–444.7) before and 435.8 ms (95% CI, 427.5–444.1) after droperidol (n = 114). Of 337 ECGs suitable for plotting on the QT nomogram, 13 (3.8%) were above the “at-risk” line; 3/136 (2.2%; 95% CI, 0.05-6.3%) in the before group, and 10/202 (4.9%; 95% CI, 2.4%-8.9%) in the after group. A single case of TdP occurred in a patient with multiple risk factors that did not reoccur after a droperidol rechallenge. Thus, the incidence of TdP was 1/16,546 (0.006%; 95% CI, 0.00015 - 0.03367%).Conclusion: We found the incidence of QTc prolongation and TdP in ED patients receiving droperidol to be extremely rare. Our data sugge

Background: ED-based trials have repeatedly failed to demonstrate superiority for antiemetic drugs over placebo,1 but the clinical significance of reported between-group differences in mean visual analogue scale (VAS) change is obscure.2 Recent research suggests that a VAS change cut-off level can reliably identify improved patients.3 This would allow more clinically meaningful between-group comparisons to be made. Objective(s): To compare intravenous (IV) droperidol 1.25 mg and ondansetron 8 mg IV with 0.9% saline placebo for adult ED patients with nausea. A VAS change cut-off level was used as the primary outcome measure. Method(s): A randomised controlled trial was conducted at Monash Health, designed to demonstrate superiority of the active drugs over placebo. The primary outcome measure of symptom improvement was defined as a VAS change of >= -8 mm from baseline at 30-minute posttreatment. Mean VAS changes per group, and percentages experiencing the desired treatment effect were also compared. Result(s): Of 215 patients, 73 (34%), 71 (33%) and 71 (33%) received droperidol, ondansetron and placebo. Symptom improvement occurred in 75%, 80% and 76% respectively; between-group differences are shown in Table 1. Mean VAS changes were -29 mm (95% CI: -36 to -23), -34 mm (95% CI: -41 to -28), and -24 mm (95% CI: -29 to -19), respectively. Desired treatment effect was experienced by 77%, 73% and 59% respectively; between-group differences are shown in Table 2. Conclusion(s): Superiority was not demonstrated for droperidol or ondansetron over placebo. The new primary outcome measure provided results which were clinically meaningful and easily understandable. (Table Presented).

Background: ED-based trials have repeatedly failed to demonstrate superiority for antiemetic drugs over placebo,1 but the clinical significance of reported between-group differences in mean visual analogue scale (VAS) change is obscure.2 Recent research suggests that a VAS change cut-off level can reliably identify improved patients.3 This would allow more clinically meaningful between-group comparisons to be made. Objective(s): To compare intravenous (IV) droperidol 1.25 mg and ondansetron 8 mg IV with 0.9% saline placebo for adult ED patients with nausea. A VAS change cut-off level was used as the primary outcome measure. Method(s): A randomised controlled trial was conducted at Monash Health, designed to demonstrate superiority of the active drugs over placebo. The primary outcome measure of symptom improvement was defined as a VAS change of >= -8 mm from baseline at 30-minute posttreatment. Mean VAS changes per group, and percentages experiencing the desired treatment effect were also compared. Result(s): Of 215 patients, 73 (34%), 71 (33%) and 71 (33%) received droperidol, ondansetron and placebo. Symptom improvement occurred in 75%, 80% and 76% respectively; between-group differences are shown in Table 1. Mean VAS changes were -29 mm (95% CI: -36 to -23), -34 mm (95% CI: -41 to -28), and -24 mm (95% CI: -29 to -19), respectively. Desired treatment effect was experienced by 77%, 73% and 59% respectively; between-group differences are shown in Table 2. Conclusion(s): Superiority was not demonstrated for droperidol or ondansetron over placebo. The new primary outcome measure provided results which were clinically meaningful and easily understandable. (Table Presented).

Background: Patients presenting to Emergency Departments (EDs) with behavioural emergencies (BEs) can be highly complex to manage. With co-morbid medical and substance abuse issues, there is an increased risk of adverse events (AEs). Objective(s): To determine the nature, frequency and severity of AEs associated with parenteral sedative medications commonly administered for BEs management in Australian EDs. Method(s): Ten Australian EDs enrolled a consecutive sample of adult patients who required parenteral sedative medication for BEs between March 2015 and April 2017. Data were collected prospectively with an explicit data collection form. Patient demographics, prescribing patterns, nature and frequency of AEs were analysed descriptively. Result(s): Overall 564 patients were enrolled; 17 patients were excluded because of incomplete documentation. Of the remaining 547 patients, 63% were male and the mean (SD) age was 38 (15) years. Intramuscular monotherapy (390/547 [71.3%, 95% CI 67.4-74.9]) was used in most cases. The main sedative medications used as monotherapy were droperidol (381/547 [69.7%, 95% CI 65.7-73.4]), midazolam (54/547 [9.9%, 95% CI 7.7-12.7]) and olanzapine (26/547 [4.8%, 95% CI 3.3-6.9]). A total of 77 AEs were identified, the most common AEs (>1% of patients) were oxygen desaturation (30/547 [5.3%, 95% CI 3.9-7.7]), airway obstruction (13/547 [2.4%, 95% CI 1.4-4.0]), bradycardia (9/547 [1.7%, 95% CI 0.9-3.1]), and hypotension (8/547 [1.6%, 95%CI 0.7-2.9]). No death or serious AEs were reported. Conclusion(s): Management of BE in Australian EDs varies considerably. Sedation-related AEs in BEs management are common, especially respiratory events. However, adverse outcomes secondary to these AEs are rare.

Background: Physostigmine is a short-acting anticholinesterase that can control anticholinergic (AC) delirium. It has a short plasma half-life and often requires re-dosing with delirium recurrence. We describe three-cases of ACdelirium treated with continuous physostigmine infusion. Case 1: A 15-year-old female-presented three-hours postingestion of 1.25g promethazine. She developed agitation and hallucination. She was treated with 10mg droperidol and 8mg lorazepam without effect. Physostigmine (0.5mg) reversed toxicity. AC-delirium recurred after 60-min. Two further 0.5mg doses were given and physostigmine infusion was commenced at 0.5mg/h with good control of mental state. No further intermittent doses were required. Total physostigmine dose over 14-h was 7.5mg. No cholinergic excess or bradycardia occurred. Case 2: A 7-year-old boy presented one-hour post-ingestion of 3.9mg hyoscine hydrobromide. He developed hallucination, aggression and paranoia, which was resistant to treatment with 15mg diazepam over eight-hours. Physostigmine (0.3mg) reversed toxicity. Ninety-minutes later a second dose (0.25mg) was given. Physostigmine infusion was commenced (0.1mg/h). Despite this, numerous repeat intermittent (25mcg) doses were given over the next 12-h for recurrence of delirium. The infusion rate was gradually increased to 0.3mg/h and no further intermittent-doses were given during the final 9 h. Total physostigmine dose over 21-h was 5.9mg. There was no cholinergic excess. Case 3: A 14-year-old female presented with agitation and hallucination 10-h post-ingestion of 250mg oxybutynin. Midazolam (1mg) and physostigmine (2mg) were given with reversal of toxicity. AC-delirium recurred after 45-min. A further dose of 2.1mg physostigmine was given and a continuous infusion started (0.5mg/hr). However, sixfurther (250mcg) intermittent doses were given for recurrent agitation without change of infusion rate. The infusion was ceased after 14-h when sleeping heart rate fell to 57

Background: Patients presenting to Emergency Departments (EDs) with behavioural emergencies (BEs) can be highly complex to manage. With co-morbid medical and substance abuse issues, there is an increased risk of adverse events (AEs). Objective(s): To determine the nature, frequency and severity of AEs associated with parenteral sedative medications commonly administered for BEs management in Australian EDs. Method(s): Ten Australian EDs enrolled a consecutive sample of adult patients who required parenteral sedative medication for BEs between March 2015 and April 2017. Data were collected prospectively with an explicit data collection form. Patient demographics, prescribing patterns, nature and frequency of AEs were analysed descriptively. Result(s): Overall 564 patients were enrolled; 17 patients were excluded because of incomplete documentation. Of the remaining 547 patients, 63% were male and the mean (SD) age was 38 (15) years. Intramuscular monotherapy (390/547 [71.3%, 95% CI 67.4-74.9]) was used in most cases. The main sedative medications used as monotherapy were droperidol (381/547 [69.7%, 95% CI 65.7-73.4]), midazolam (54/547 [9.9%, 95% CI 7.7-12.7]) and olanzapine (26/547 [4.8%, 95% CI 3.3-6.9]). A total of 77 AEs were identified, the most common AEs (>1% of patients) were oxygen desaturation (30/547 [5.3%, 95% CI 3.9-7.7]), airway obstruction (13/547 [2.4%, 95% CI 1.4-4.0]), bradycardia (9/547 [1.7%, 95% CI 0.9-3.1]), and hypotension (8/547 [1.6%, 95%CI 0.7-2.9]). No death or serious AEs were reported. Conclusion(s): Management of BE in Australian EDs varies considerably. Sedation-related AEs in BEs management are common, especially respiratory events. However, adverse outcomes secondary to these AEs are rare.

Background: Physostigmine is a short-acting anticholinesterase that can control anticholinergic (AC) delirium. It has a short plasma half-life and often requires re-dosing with delirium recurrence. We describe three-cases of ACdelirium treated with continuous physostigmine infusion. Case 1: A 15-year-old female-presented three-hours postingestion of 1.25g promethazine. She developed agitation and hallucination. She was treated with 10mg droperidol and 8mg lorazepam without effect. Physostigmine (0.5mg) reversed toxicity. AC-delirium recurred after 60-min. Two further 0.5mg doses were given and physostigmine infusion was commenced at 0.5mg/h with good control of mental state. No further intermittent doses were required. Total physostigmine dose over 14-h was 7.5mg. No cholinergic excess or bradycardia occurred. Case 2: A 7-year-old boy presented one-hour post-ingestion of 3.9mg hyoscine hydrobromide. He developed hallucination, aggression and paranoia, which was resistant to treatment with 15mg diazepam over eight-hours. Physostigmine (0.3mg) reversed toxicity. Ninety-minutes later a second dose (0.25mg) was given. Physostigmine infusion was commenced (0.1mg/h). Despite this, numerous repeat intermittent (25mcg) doses were given over the next 12-h for recurrence of delirium. The infusion rate was gradually increased to 0.3mg/h and no further intermittent-doses were given during the final 9 h. Total physostigmine dose over 21-h was 5.9mg. There was no cholinergic excess. Case 3: A 14-year-old female presented with agitation and hallucination 10-h post-ingestion of 250mg oxybutynin. Midazolam (1mg) and physostigmine (2mg) were given with reversal of toxicity. AC-delirium recurred after 45-min. A further dose of 2.1mg physostigmine was given and a continuous infusion started (0.5mg/hr). However, sixfurther (250mcg) intermittent doses were given for recurrent agitation without change of infusion rate. The infusion was ceased after 14-h when sleeping heart rate fell to 57

BACKGROUND: The high prevalence of comorbid illicit drug use in persons with chronic psychotic illness represents a strong determinant of psychotic relapse and rehospitalization. Epidemiological studies indicate changing patterns of illicit drug use in Australia, which are concerning because of increased use of crystal methamphetamine, also known as "ice." An important complication of habitual use of crystal methamphetamine is the development of a dose-dependent acute psychotic reaction. We report a case of an acute psychotic relapse in response to polydrug use most notable for multiple recent binges of crystal methamphetamine. Unlike previously described case reports, our patient's acute psychosis was refractory to ultra-high doses of multiple antipsychotic medications. This presented safety challenges due to the risk of serious side effects with high-dose antipsychotic medications. CASE PRESENTATION: A 30-year-old white man with a past history of schizoaffective disorder was brought to our emergency department by the police in a state of extreme agitation, combativeness, and paranoia after use of cannabis and crystal methamphetamine. Despite existing compliance with zuclopenthixol decanoate depot medication, he required multiple emergency injections of zuclopenthixol acetate, and regular high-dose droperidol, chlorpromazine, and lorazepam. However, he remained severely agitated and psychotic with continuous threats of harm to others. A test of antipsychotic drug metabolism by cytochrome P450 enzymes did not reveal a pharmacogenetic cause for the poor therapeutic efficacy of antipsychotic medications. His psychosis did not appear to be modified by psychoactive medications but was instead self-limited to the presence of endogenous methamphetamine within his system. He fully recovered 96 to 120 hours post-presentation and was discharged home with out-patient clinic follow-up. CONCLUSIONS: The current case highlight

BackgroundAlthough first-generation antipsychotics (FGAs) have long been used in the emergency department (ED) to treat acute agitation, little is known about how these medications are used in modern clinical practice. In particular, little work has been published about whether ED clinicians administer FGAs with adjunctive medications in accordance with expert guidelines or the prescribing practices of FGAs over time.Objectives1) To provide a comparison of the frequency with which FGAs are administered with adjunctive benzodiazepines or anticholinergic medications. 2) To analyze the prescribing trends for FGAs over time, particularly in the years after the U.S. Food and Drug Administration (FDA) black-box warning for droperidol.MethodsThis is a structured review of a retrospective cohort of patients receiving haloperidol or droperidol in two EDs over a 7-year period.ResultsHaloperidol or droperidol was administered on 2833 patient visits during the study period, with haloperidol being administered most often. Adjunctive medications are administered less than half of the time. The use of droperidol has remained relatively static, whereas the use of haloperidol has increased.ConclusionsFirst-generation antipsychotics are still widely utilized in the ED. When administered, these medications are used with adjunctive medications that may decrease side effects less than half of the time. Droperidol use has remained unchanged in the years after the FDA black-box warning, whereas use of haloperidol has continued to rise.

BackgroundAlthough first-generation antipsychotics (FGAs) have long been used in the emergency department (ED) to treat acute agitation, little is known about how these medications are used in modern clinical practice. In particular, little work has been published about whether ED clinicians administer FGAs with adjunctive medications in accordance with expert guidelines or the prescribing practices of FGAs over time.Objectives1) To provide a comparison of the frequency with which FGAs are administered with adjunctive benzodiazepines or anticholinergic medications. 2) To analyze the prescribing trends for FGAs over time, particularly in the years after the U.S. Food and Drug Administration (FDA) black-box warning for droperidol.MethodsThis is a structured review of a retrospective cohort of patients receiving haloperidol or droperidol in two EDs over a 7-year period.ResultsHaloperidol or droperidol was administered on 2833 patient visits during the study period, with haloperidol being administered most often. Adjunctive medications are administered less than half of the time. The use of droperidol has remained relatively static, whereas the use of haloperidol has increased.ConclusionsFirst-generation antipsychotics are still widely utilized in the ED. When administered, these medications are used with adjunctive medications that may decrease side effects less than half of the time. Droperidol use has remained unchanged in the years after the FDA black-box warning, whereas use of haloperidol has continued to rise.

type:Departmental Bulletin Paper, [Abstract] Purpose : Sevoflurane and droperidol but not propofol induce QTc interval prolongation, but there are several conflicting reports. We investigated the effects of sevoflurane and propofol with or without an anti-emetic dose of droperidol on the QTc interval and the transmural dispersion of repolarization for 2 hours, and the QT interval was adjusted for the patient's heart rate using 3 formulae. Methods : One hundred two American Society of Anesthesiologists (ASA) physical status I-II patients, aged 20-70, were randomly allocated to one of four groups : Group 1 (n＝25) receiving sevoflurane anesthesia without droperidol (1.25 mg), Group 2 (n＝26) receiving sevoflurane anesthesia with droperidol, Group 3 (n＝ 25) receiving propofol anesthesia without droperidol, or Group 4 (n＝26) receiving propofol anesthesia with droperidol. RR intervals, QT intervals, and Tp-e intervals, which indicates the dispersion of ventricular repolarization (TDR), were mea-sured. The QT interval was adjusted for the patient's heart rate using the formulae of Bazett, Fridericia, and Matsunaga. Results : Sevoflurane significantly prolonged the QTc, but droperidol did not enhance sevoflurane- induced QTc prolongation in all the formulae. Conversely, propofol did not affect the QTc in all formulae. Tp-e intervals were not affected in any of the groups. Conclusion : Although it significantly prolongs the QTc interval, sevoflurane, even with droperidol, does not seem to cause lethal arrhythmias associated with QT prolongation, because it does not induce Tp-e prolongation. Propofol is safer than sevoflurane in terms of arrhythmias associated with QT interval prolongation. Bazett's formula is reliable for detecting anesthetic- induced QT prolongation.

In this paper, extraction kinetics was investigated experimentally and theoretically in hollow fiber liquid-phase microextraction (HF-LPME) and electromembrane extraction (EME) with the basic drugs droperidol, haloperidol, nortriptyline, clomipramine, and clemastine as model analytes. In HF-LPME, the analytes were extracted by passive diffusion from an alkaline sample, through a (organic) supported liquid membrane (SLM) and into an acidic acceptor solution. In EME, the analytes were extracted by electrokinetic migration from an acidic sample, through the SLM, and into an acidic acceptor solution by application of an electrical potential across the SLM. In both HF-LPME and EME, the sample (donor solution) was found to be rapidly depleted for analyte. In HF-LPME, the mass transfer across the SLM was slow, and this was found to be the rate limiting step of HF-LPME. This finding is in contrast to earlier discussions in the literature suggesting that mass transfer across the boundary layer at the donor-SLM interface is the rate limiting step of HF-LPME. In EME, mass transfer across the SLM was much more rapid due to electrokinetic migration. Nevertheless, mass transfer across the SLM was rate limiting even in EME. Theoretical models were developed to describe the kinetics in HF-LPME, in agreement with the experimental findings. In HF-LPME, the extraction efficiency was found to be maintained even if pH in the donor solution was lowered from 10 to 7-8, which was below the pK(a)-value for several of the analytes. Similarly, in EME, the extraction efficiency was found to be maintained even if pH in the donor solution increased from 4 to 11, which was above the pK(a)-value for several of the analytes. The two latter experiments suggested that both techniques may be used to effectively extract analytes from samples in a broader pH range as compared to the pH range recommended in the literature.

In this paper, extraction kinetics was investigated experimentally and theoretically in hollow fiber liquid-phase microextraction (HF-LPME) and electromembrane extraction (EME) with the basic drugs droperidol, haloperidol, nortriptyline, clomipramine, and clemastine as model analytes. In HF-LPME, the analytes were extracted by passive diffusion from an alkaline sample, through a (organic) supported liquid membrane (SLM) and into an acidic acceptor solution. In EME, the analytes were extracted by electrokinetic migration from an acidic sample, through the SLM, and into an acidic acceptor solution by application of an electrical potential across the SLM. In both HF-LPME and EME, the sample (donor solution) was found to be rapidly depleted for analyte. In HF-LPME, the mass transfer across the SLM was slow, and this was found to be the rate limiting step of HF-LPME. This finding is in contrast to earlier discussions in the literature suggesting that mass transfer across the boundary layer at the donor-SLM interface is the rate limiting step of HF-LPME. In EME, mass transfer across the SLM was much more rapid due to electrokinetic migration. Nevertheless, mass transfer across the SLM was rate limiting even in EME. Theoretical models were developed to describe the kinetics in HF-LPME, in agreement with the experimental findings. In HF-LPME, the extraction efficiency was found to be maintained even if pH in the donor solution was lowered from 10 to 7-8, which was below the pK(a)-value for several of the analytes. Similarly, in EME, the extraction efficiency was found to be maintained even if pH in the donor solution increased from 4 to 11, which was above the pK(a)-value for several of the analytes. The two latter experiments suggested that both techniques may be used to effectively extract analytes from samples in a broader pH range as compared to the pH range recommended in the literature.

Postoperativt illamående och kräkningar, PONV, har sedan anestesins begynnelse vållat patienten stort lidande. Tillståndet kan förlänga den postoperativa vistelsen och är en av de vanligaste orsakerna till oplanerad inläggning av patienter i samband med dagkirurgi. Syftet med föreliggande arbete var att undersöka den förebyggande effekten av akupressur som ensam intervention eller i kombination med viss farmakologisk antiemetisk terapi vid postoperativt illamående och kräkningar hos vuxna patienter efter allmänkirurgi. En systematisk litteraturstudie genomfördes och tio vetenskapliga artiklar inkluderades och kvalitetsbedömdes. Sökning utfördes i databaserna PubMed, EBSCO HOST och Cochrane Library. Dessutom genomfördes manuell sökning. Resultatet visade att akupressur på en speciell triggerpunkt, P6, har en förebyggande effekt mot PONV. Ondansetron och akupressur är lika effektivt mot PONV, medan Droperidol verkar ha bättre effekt än akupressur. Slutsatsen var att akupressur har en plats som profylaktisk antiemetika för att förebygga PONV., Postoperative nausea and vomiting (PONV) has since the beginning of anesthesia caused the patient great suffering. It can prolong the post-operative stay and is one of the most common reasons for unplanned admittance of patients in connection to day surgery. The aim of this work was to study the preventive effect of acupressure as the lone intervention or in combination with certain pharmacological antiemetic therapies for post-operative nausea and vomiting in adult patients who have undergone general surgery. A systematic literature review was conducted and ten articles were included and each study subjected to a quality assessment. A PubMed, EBSCO HOST and Cochrane Library Database were conducted and a manual search of the literature references completed the search.The results showed that acupressure at the P6 meridian point has a preventive effect against PONV and that Ondansetron and acupressure are similarly effective against PONV, while Droperidal seems to have a better effect than acupressure. The conclusion was that acupressure can be used prophylactic to prevent PONV.

Postoperativt illamående och kräkningar, PONV, har sedan anestesins begynnelse vållat patienten stort lidande. Tillståndet kan förlänga den postoperativa vistelsen och är en av de vanligaste orsakerna till oplanerad inläggning av patienter i samband med dagkirurgi. Syftet med föreliggande arbete var att undersöka den förebyggande effekten av akupressur som ensam intervention eller i kombination med viss farmakologisk antiemetisk terapi vid postoperativt illamående och kräkningar hos vuxna patienter efter allmänkirurgi. En systematisk litteraturstudie genomfördes och tio vetenskapliga artiklar inkluderades och kvalitetsbedömdes. Sökning utfördes i databaserna PubMed, EBSCO HOST och Cochrane Library. Dessutom genomfördes manuell sökning. Resultatet visade att akupressur på en speciell triggerpunkt, P6, har en förebyggande effekt mot PONV. Ondansetron och akupressur är lika effektivt mot PONV, medan Droperidol verkar ha bättre effekt än akupressur. Slutsatsen var att akupressur har en plats som profylaktisk antiemetika för att förebygga PONV., Postoperative nausea and vomiting (PONV) has since the beginning of anesthesia caused the patient great suffering. It can prolong the post-operative stay and is one of the most common reasons for unplanned admittance of patients in connection to day surgery. The aim of this work was to study the preventive effect of acupressure as the lone intervention or in combination with certain pharmacological antiemetic therapies for post-operative nausea and vomiting in adult patients who have undergone general surgery. A systematic literature review was conducted and ten articles were included and each study subjected to a quality assessment. A PubMed, EBSCO HOST and Cochrane Library Database were conducted and a manual search of the literature references completed the search.The results showed that acupressure at the P6 meridian point has a preventive effect against PONV and that Ondansetron and acupressure are similarly effective against PONV, while Droperidal seems to have a better effect than acupressure. The conclusion was that acupressure can be used prophylactic to prevent PONV.

Numerous difficulties arise during in vivo measurements of transepithelial nasal potential difference (PD) in mice, such as inadequate duration and depth of anaesthesia, bronchoaspiration of solutions perfused in the nose, and respiratory and/or cardiovascular depression. Anaesthesia was induced in adult C57 mice with intraperitoneal injection of a combination of fentanyl, droperidol and medetomidine, each of these at either a small dose (0.20, 10 and 0.33 mg/kg, respectively) or at a large dose (0.40, 20 and 0.40 mg/kg, respectively), combined with a fixed dose of 0.375 microg clonidine. In order to establish a pharmacokinetic-pharmacodynamic relationship, blood concentrations of the first three drugs were measured in 24 animals by liquid-chromatography tandem mass spectrometry. At the end of the experiment, naloxone, a competitive morphinic antagonist, and atipamezole, an alpha-2 adrenergic antagonist, were administered. Bronchoaspiration was prevented by tilting the animal head downwards and by absorbing the excess fluid from the opposite nostril and from the oral cavity. Optimal assessment of anaesthesia associated with regular respiration, loss of blink, pupillary and pedal withdrawal reflexes was obtained with doses of fentanyl, droperidol and medetomidine corresponding to 0.20, 20 and 0.40 mg/kg, respectively. Blood concentrations of fentanyl around 17 ng/mL induced loss of respiratory efforts and were followed by death during the experiment. Integrity of ion transport was demonstrated under continuous perfusion by successive depolarization after amiloride and repolarization after chloride-free solution. The combination investigated in this study lead to adequate surgical anaesthesia (stage III, plane 2) for prolonged nasal PD measurements in spontaneously breathing mice.

Symptoms after surgery and anaesthesia influence the patient´s ability to resume daily activities. If postoperative symptoms are controlled rehabilitation may be accelerated. The aims of this dissertation were to identify disturbing symptoms reported by patients after gynaecological surgery, to investigate what effect prohylactic treatment with antiemetics has on these symptoms and whether or not sensory simulation of the P6-acupressure has an effect on postoperative nausea and vomiting (PONV) and motion sickness. Methods: Total 1138 women participated in three clinical trials (Studies I, II, III) and one experimental study (Study IV). A questionnaire investigating postoperative symptoms was constructed and validated. The questionnaire was used in a prospective, consecutive, doubleblind, randomised, multicentre, and controlled study to identify incidence, and intensity of postoperative symptoms and the effect of common antiemetics (droperidol and granisetron) (Study III). The patients were followed for 24 h. In two studies (I, II) P6-acupressure was compared (prospective, double-blind, ransomised, controlled) with placebo acupressure and a reference group where the effect on PONV was followed over 24 h. The effect of P6-acupressure and placebo acupressure on motion sickness induced by a nauseogenic motion challenge was studied (Study III). Results: A high incidence and severity of postoperative symptoms were found after gynaecological surgery in a group with a high risk (>30%) for PONV. Sixty-four per cent (107/165) of the patients experienced disturbing symptoms after surgery and 46 % (76/165) scored their symptoms as moderate to very severe. Fourty-eight per cent (79/165) had two or more symptoms. A higher incidence of symptoms were reported in the groups with prophylactic treatment, granisetron 74% (123/165) and droperidol 80% (133/165) compared to the control group 41% (69/165) (P <0.05). The relative risk reduction for PONV with granisetron or droperidol, On the day of the public defence the status of article IV was: Submitted.

BOLD-contrast functional magnetic resonance imaging (MRI) was used to assess the evolution of tumor oxygenation and blood flow after administration of four different anesthetics: pentobarbital (60 mg/kg), ketamine/xylazine (80/8 mg/kg), fentanyl/droperidol (0.078/3.9 mg/kg), and isoflurane (1.5%). Gradient echo sequences were carried out at 4.7 Tesla in a TLT tumor model implanted in the muscle of NMRI mice. In parallel experiments, tumor blood flow and tumor pO2 were measured using the OxyLite/OxyFlo probe system. A comparison was made with the changes occurring in the skeletal muscle (host tissue). The signal intensity was dramatically decreased in tumors after administration of anesthetics, except isoflurane. These results correlated well with measurements of oxygenation and blood perfusion. Isoflurane produced constant muscle pO2 and blood perfusion although large transient fluctuations in pO2 and blood flow were reported in some tumors. Our results emphasize the need for careful monitoring of the effects of anesthesia when trying to identify new therapeutic approaches that are aimed at modulating tumor hemodynamics.

Symptoms after surgery and anaesthesia influence the patient´s ability to resume daily activities. If postoperative symptoms are controlled rehabilitation may be accelerated. The aims of this dissertation were to identify disturbing symptoms reported by patients after gynaecological surgery, to investigate what effect prohylactic treatment with antiemetics has on these symptoms and whether or not sensory simulation of the P6-acupressure has an effect on postoperative nausea and vomiting (PONV) and motion sickness. Methods: Total 1138 women participated in three clinical trials (Studies I, II, III) and one experimental study (Study IV). A questionnaire investigating postoperative symptoms was constructed and validated. The questionnaire was used in a prospective, consecutive, doubleblind, randomised, multicentre, and controlled study to identify incidence, and intensity of postoperative symptoms and the effect of common antiemetics (droperidol and granisetron) (Study III). The patients were followed for 24 h. In two studies (I, II) P6-acupressure was compared (prospective, double-blind, ransomised, controlled) with placebo acupressure and a reference group where the effect on PONV was followed over 24 h. The effect of P6-acupressure and placebo acupressure on motion sickness induced by a nauseogenic motion challenge was studied (Study III). Results: A high incidence and severity of postoperative symptoms were found after gynaecological surgery in a group with a high risk (>30%) for PONV. Sixty-four per cent (107/165) of the patients experienced disturbing symptoms after surgery and 46 % (76/165) scored their symptoms as moderate to very severe. Fourty-eight per cent (79/165) had two or more symptoms. A higher incidence of symptoms were reported in the groups with prophylactic treatment, granisetron 74% (123/165) and droperidol 80% (133/165) compared to the control group 41% (69/165) (P <0.05). The relative risk reduction for PONV with granisetron or droperidol, On the day of the public defence the status of article IV was: Submitted.

Symptoms after surgery and anaesthesia influence the patient´s ability to resume daily activities. If postoperative symptoms are controlled rehabilitation may be accelerated. The aims of this dissertation were to identify disturbing symptoms reported by patients after gynaecological surgery, to investigate what effect prohylactic treatment with antiemetics has on these symptoms and whether or not sensory simulation of the P6-acupressure has an effect on postoperative nausea and vomiting (PONV) and motion sickness. Methods: Total 1138 women participated in three clinical trials (Studies I, II, III) and one experimental study (Study IV). A questionnaire investigating postoperative symptoms was constructed and validated. The questionnaire was used in a prospective, consecutive, doubleblind, randomised, multicentre, and controlled study to identify incidence, and intensity of postoperative symptoms and the effect of common antiemetics (droperidol and granisetron) (Study III). The patients were followed for 24 h. In two studies (I, II) P6-acupressure was compared (prospective, double-blind, ransomised, controlled) with placebo acupressure and a reference group where the effect on PONV was followed over 24 h. The effect of P6-acupressure and placebo acupressure on motion sickness induced by a nauseogenic motion challenge was studied (Study III). Results: A high incidence and severity of postoperative symptoms were found after gynaecological surgery in a group with a high risk (>30%) for PONV. Sixty-four per cent (107/165) of the patients experienced disturbing symptoms after surgery and 46 % (76/165) scored their symptoms as moderate to very severe. Fourty-eight per cent (79/165) had two or more symptoms. A higher incidence of symptoms were reported in the groups with prophylactic treatment, granisetron 74% (123/165) and droperidol 80% (133/165) compared to the control group 41% (69/165) (P <0.05). The relative risk reduction for PONV with granisetron or droperidol, On the day of the public defence the status of article IV was: Submitted.

Symptoms after surgery and anaesthesia influence the patient´s ability to resume daily activities. If postoperative symptoms are controlled rehabilitation may be accelerated. The aims of this dissertation were to identify disturbing symptoms reported by patients after gynaecological surgery, to investigate what effect prohylactic treatment with antiemetics has on these symptoms and whether or not sensory simulation of the P6-acupressure has an effect on postoperative nausea and vomiting (PONV) and motion sickness. Methods: Total 1138 women participated in three clinical trials (Studies I, II, III) and one experimental study (Study IV). A questionnaire investigating postoperative symptoms was constructed and validated. The questionnaire was used in a prospective, consecutive, doubleblind, randomised, multicentre, and controlled study to identify incidence, and intensity of postoperative symptoms and the effect of common antiemetics (droperidol and granisetron) (Study III). The patients were followed for 24 h. In two studies (I, II) P6-acupressure was compared (prospective, double-blind, ransomised, controlled) with placebo acupressure and a reference group where the effect on PONV was followed over 24 h. The effect of P6-acupressure and placebo acupressure on motion sickness induced by a nauseogenic motion challenge was studied (Study III). Results: A high incidence and severity of postoperative symptoms were found after gynaecological surgery in a group with a high risk (>30%) for PONV. Sixty-four per cent (107/165) of the patients experienced disturbing symptoms after surgery and 46 % (76/165) scored their symptoms as moderate to very severe. Fourty-eight per cent (79/165) had two or more symptoms. A higher incidence of symptoms were reported in the groups with prophylactic treatment, granisetron 74% (123/165) and droperidol 80% (133/165) compared to the control group 41% (69/165) (P <0.05). The relative risk reduction for PONV with granisetron or droperidol, On the day of the public defence the status of article IV was: Submitted.

Na presente pesquisa, avaliou-se a associação midazolam/droperidol na tranqüilização de 11 suínos da raça Landrace. Foram analisadas as frequências cardíaca, respiratória, temperatura retal e hemogasimetria arterial antes e após a administração do midazolam (0,4mg/kg IM) associado ao droperidol (0,4mg/kg IM). As anotações paramétricas e análises hemogasimétricas foram realizadas a intervalos de 10 minutos, durante uma hora após a administração das drogas. Concomitantemente efetuaram-se observações clínicas a respeito da eficácia da tranqüilização. Não ocorreram alterações significativas nos parâmetros de frequência cardíaca e equilíbrio ácido-base. A frequência respiratória diminuiu significativamente, quando comparada aos valores basais. O tempo médio de ação das drogas foi de 60 minutos, com período de latência de 3 minutos. Durante a tranqüilização houve relaxamento muscular, perda dos reflexos posturais, indiferença ao meio ambiente e manutenção dos reflexos protetores. A análise dos resultados permite indicar a associação midazolam/droperidol para a tranqüilização/sedação de suínos. The association midazolam/droperidol was evaluated in the chemical restraint of 11 Landrace swines. Cardiac and respiratory rates were studied as well as rectal temperature and blood gas analisis after and before the midazolam (0.4mg/kg)/droperidol (0.4mg/kg) injection. The parametrical values and the blood gas analisis were performed during an hour period after drug administration, at 10 minutes intervals. At the same time, clinical trials were performed about the effectiveness of the tranquilization. Significant changes did not occur in the heart rate and acid-basic equilibrium. The respiratory rate decreased significantly, when compared to basal measurements. The set time of the drug action was that of 60 minutes, with an onset period of 3 minutes. During the tranquilization it was observed muscle relief, loss of the postural reflexos, abscence to environmental stimulus and kee

In children, strabismus surgery is frequently followed by vomiting. The present study compares the antiemetic effects of droperidol (10 micrograms/kg) and/or metoclopramide (0.1 mg/kg) in 104 children undergoing strabismus surgery. The patients were randomly divided into four groups. Group I (n = 28) received placebo (saline), Group II (n = 26) droperidol 10 micrograms/kg, Group III (n = 25) metoclopramide 0.1 mg/kg and Group IV (n = 25) droperidol 10 micrograms/kg and metoclopramide 0.1 mg/kg. Droperidol was given just after induction and metoclopramide at the end of surgery, just before recovery. The technique of anesthesia involved an anticholinergic premedication, IV fentanyl (2 micrograms/kg), controlled ventilation using isoflurance and N2O in oxygen and systematic gastric emptying before extubation. Vomiting, retching and nausea were noted at 5 different moments: in the Post Anesthetic Care Unit, when arriving on the ward (= after carriage by lift), during the first hour following the return in the ward, from the 6th to the 12th postoperative hour and on the morning of day 1. There was no statistically significant difference in the incidence of vomiting among these four groups. Moreover, the incidence of vomiting in the placebo group was much lower (17.9% in the recovery room, 3.6% at return in the ward, 25% during the first hour, 7.1% from 6 to 12 hours and 3.6% the next day) than that reported in previous studies. We think that this could result from the additive effects of some aspects of the technique of anesthesia described and discussed in this paper.

Eight patients with stable ischaemic heart disease were investigated to determine the effects of fentanyl (15 micrograms/kg) - droperidol (150 micrograms/kg) - nitrous oxide (75%) anaesthesia, without concomitant fluid challenge, on myocardial oxygen consumption and lactate uptake, and central and coronary haemodynamics. Anaesthesia induced reductions in mean arterial pressure (--35%, P less than 0.01), systemic vascular resistance (--30%, P less than 0.01), left ventricular stroke work index (--50%, P less than 0.01) and total body oxygen consumption (--23%, P less than 0.01), with no changes in heart rate, cardiac output or mean pulmonary arteriolar occlusion pressure. Mixed venous oxygen content increased (P less than 0.05). Systemic vasodilatation, circulatory adaptation to an overall lower metabolic rate, and clinically negligible cardiodepression are the likely mechanisms behind the central haemodynamic response to this form of anaesthesia. Coronary sinus blood flow (measured by the continuous thermodilution technique) decreased (P less than 0.01) in parallel with the decrease in coronary perfusion pressure. Thus coronary vascular resistance remained unchanged. As expected from the haemodynamic findings, myocardial oxygen consumption decreased (--37%, P less than 0.01). Coronary sinus oxygen content and myocardial oxygen extraction did not change, nor was myocardial lactate uptake affected. No ST-T-segment depressions or dysrhythmias were recorded. These observations indicate that myocardial oxygenation was adequate in spite of the reduction in coronary perfusion pressure. There was poor correlation between changes in myocardial oxygen consumption and rate pressure product (R = 0.455) or triple produce (R - 0.375)., Reiz, S Balfors, E Haggmark, S Nath, S Rydvall, A Truedsson, H Comparative Study Denmark Acta anaesthesiologica Scandinavica Acta Anaesthesiol Scand. 1981 Jun;25(3):286-92.