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David Castle - One of the best experts on this subject based on the ideXlab platform.
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intravenous midazolam Droperidol combination Droperidol or olanzapine monotherapy for methamphetamine related acute agitation subgroup analysis of a randomized controlled trial
Addiction, 2017Co-Authors: Celene Y. L. Yap, Simone E Taylor, Georgina A Phillips, Jonathan Karro, David C M Kong, Jonathan C Knott, Esther W Chan, David Taylor, David CastleAbstract:Aim To examine the efficacy and safety of (1) midazolam–Droperidol versus Droperidol and (2) midazolam–Droperidol versus olanzapine for methamphetamine-related acute agitation. Design and setting A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Participants Three hundred and sixty-one patients, aged 18–65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Intervention and comparator Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg–Droperidol 5 mg combined, Droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, Droperidol 5 mg or olanzapine 5 mg, respectively. Measurements The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. Findings The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam–Droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the Droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02–21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74–19.33]. The number of patients who experienced an adverse event (AE) in the midazolam–Droperidol, Droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. Conclusion A midazolam–Droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than Droperidol or olanzapine alone.
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Intravenous midazolam–Droperidol combination, Droperidol or olanzapine monotherapy for methamphetamine‐related acute agitation: subgroup analysis of a randomized controlled trial
Addiction (Abingdon England), 2017Co-Authors: Celene Y. L. Yap, Simone E Taylor, Jonathan Karro, David C M Kong, Jonathan C Knott, Esther W Chan, David Taylor, Georgina Phillips, David CastleAbstract:To examine the efficacy and safety of (1) midazolam-Droperidol versus Droperidol and (2) midazolam-Droperidol versus olanzapine for methamphetamine-related acute agitation. A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Three hundred and sixty-one patients, aged 18-65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg-Droperidol 5 mg combined, Droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, Droperidol 5 mg or olanzapine 5 mg, respectively. The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam-Droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the Droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02-21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74-19.33]. The number of patients who experienced an adverse event (AE) in the midazolam-Droperidol, Droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. A midazolam-Droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than Droperidol or olanzapine alone. © 2017 Society for the Study of Addiction.
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Midazolam-Droperidol, Droperidol, or olanzapine for acute agitation: a randomized clinical trial
Annals of emergency medicine, 2016Co-Authors: David Taylor, Celene Y. L. Yap, Simone E Taylor, Jonathan Karro, David C M Kong, Jonathan C Knott, Esther W Chan, Georgina Phillips, David CastleAbstract: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.
Celene Y. L. Yap - One of the best experts on this subject based on the ideXlab platform.
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intravenous midazolam Droperidol combination Droperidol or olanzapine monotherapy for methamphetamine related acute agitation subgroup analysis of a randomized controlled trial
Addiction, 2017Co-Authors: Celene Y. L. Yap, Simone E Taylor, Georgina A Phillips, Jonathan Karro, David C M Kong, Jonathan C Knott, Esther W Chan, David Taylor, David CastleAbstract:Aim To examine the efficacy and safety of (1) midazolam–Droperidol versus Droperidol and (2) midazolam–Droperidol versus olanzapine for methamphetamine-related acute agitation. Design and setting A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Participants Three hundred and sixty-one patients, aged 18–65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Intervention and comparator Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg–Droperidol 5 mg combined, Droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, Droperidol 5 mg or olanzapine 5 mg, respectively. Measurements The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. Findings The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam–Droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the Droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02–21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74–19.33]. The number of patients who experienced an adverse event (AE) in the midazolam–Droperidol, Droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. Conclusion A midazolam–Droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than Droperidol or olanzapine alone.
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Intravenous midazolam–Droperidol combination, Droperidol or olanzapine monotherapy for methamphetamine‐related acute agitation: subgroup analysis of a randomized controlled trial
Addiction (Abingdon England), 2017Co-Authors: Celene Y. L. Yap, Simone E Taylor, Jonathan Karro, David C M Kong, Jonathan C Knott, Esther W Chan, David Taylor, Georgina Phillips, David CastleAbstract:To examine the efficacy and safety of (1) midazolam-Droperidol versus Droperidol and (2) midazolam-Droperidol versus olanzapine for methamphetamine-related acute agitation. A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Three hundred and sixty-one patients, aged 18-65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg-Droperidol 5 mg combined, Droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, Droperidol 5 mg or olanzapine 5 mg, respectively. The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam-Droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the Droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02-21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74-19.33]. The number of patients who experienced an adverse event (AE) in the midazolam-Droperidol, Droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. A midazolam-Droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than Droperidol or olanzapine alone. © 2017 Society for the Study of Addiction.
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Midazolam-Droperidol, Droperidol, or olanzapine for acute agitation: a randomized clinical trial
Annals of emergency medicine, 2016Co-Authors: David Taylor, Celene Y. L. Yap, Simone E Taylor, Jonathan Karro, David C M Kong, Jonathan C Knott, Esther W Chan, Georgina Phillips, David CastleAbstract: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.
David Taylor - One of the best experts on this subject based on the ideXlab platform.
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intravenous midazolam Droperidol combination Droperidol or olanzapine monotherapy for methamphetamine related acute agitation subgroup analysis of a randomized controlled trial
Addiction, 2017Co-Authors: Celene Y. L. Yap, Simone E Taylor, Georgina A Phillips, Jonathan Karro, David C M Kong, Jonathan C Knott, Esther W Chan, David Taylor, David CastleAbstract:Aim To examine the efficacy and safety of (1) midazolam–Droperidol versus Droperidol and (2) midazolam–Droperidol versus olanzapine for methamphetamine-related acute agitation. Design and setting A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Participants Three hundred and sixty-one patients, aged 18–65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Intervention and comparator Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg–Droperidol 5 mg combined, Droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, Droperidol 5 mg or olanzapine 5 mg, respectively. Measurements The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. Findings The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam–Droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the Droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02–21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74–19.33]. The number of patients who experienced an adverse event (AE) in the midazolam–Droperidol, Droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. Conclusion A midazolam–Droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than Droperidol or olanzapine alone.
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Intravenous midazolam–Droperidol combination, Droperidol or olanzapine monotherapy for methamphetamine‐related acute agitation: subgroup analysis of a randomized controlled trial
Addiction (Abingdon England), 2017Co-Authors: Celene Y. L. Yap, Simone E Taylor, Jonathan Karro, David C M Kong, Jonathan C Knott, Esther W Chan, David Taylor, Georgina Phillips, David CastleAbstract:To examine the efficacy and safety of (1) midazolam-Droperidol versus Droperidol and (2) midazolam-Droperidol versus olanzapine for methamphetamine-related acute agitation. A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Three hundred and sixty-one patients, aged 18-65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg-Droperidol 5 mg combined, Droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, Droperidol 5 mg or olanzapine 5 mg, respectively. The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam-Droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the Droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02-21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74-19.33]. The number of patients who experienced an adverse event (AE) in the midazolam-Droperidol, Droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. A midazolam-Droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than Droperidol or olanzapine alone. © 2017 Society for the Study of Addiction.
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Midazolam-Droperidol, Droperidol, or olanzapine for acute agitation: a randomized clinical trial
Annals of emergency medicine, 2016Co-Authors: David Taylor, Celene Y. L. Yap, Simone E Taylor, Jonathan Karro, David C M Kong, Jonathan C Knott, Esther W Chan, Georgina Phillips, David CastleAbstract: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.
Pamela Flood - One of the best experts on this subject based on the ideXlab platform.
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Droperidol Inhibits GABAAand Neuronal Nicotinic Receptor Activation
Anesthesiology, 2002Co-Authors: Pamela Flood, Kristen CoatesAbstract:Droperidol is used in neuroleptanesthesia and as an antiemetic. Although its antiemetic effect is thought to be caused by dopaminergic inhibition, the mechanism of Droperidol's anesthetic action is unknown. Because gamma-aminobutyric acid type A (GABAA) and neuronal nicotinic acetylcholine receptors (nAChRs) have been implicated as putative targets of other general anesthetic drugs, the authors tested the ability of Droperidol to modulate these receptors. gamma-Aminobutyric acid type A alpha1beta1gamma2 receptor, alpha7 and alpha4beta2 nAChRs were expressed in Xenopus oocytes and studied with two-electrode voltage clamp recording. The authors tested the ability of Droperidol at concentrations from 1 nm to 100 microm to modulate activation of these receptors by their native agonists. Droperidol inhibited the GABA response by a maximum of 24.7 +/- 3.0%. The IC50 for inhibition was 12.6 +/- 0.47 nm Droperidol. At high concentrations, Droperidol (100 microm) activates the GABAA receptor in the absence of GABA. Inhibition of the GABA response is significantly greater at hyperpolarized membrane potentials. The activation of the alpha7 nAChR is also inhibited by Droperidol, with an IC50 of 5.8 +/- 0.53 microm. The Hill coefficient is 0.95 +/- 0.1. Inhibition is noncompetitive, and membrane voltage dependence is insignificant. Droperidol inhibits activation of both the GABAA alpha1beta1gamma2 and alpha7 nAChR. The submaximal GABA inhibition occurs within a concentration range such that it might be responsible for the anxiety, dysphoria, and restlessness that limit the clinical utility of high-dose Droperidol anesthesia. Inhibition of the alpha7 nAChR might be responsible for the anesthetic action of Droperidol.
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Droperidol Inhibits GABAAand Neuronal Nicotinic Receptor Activation
Anesthesiology, 2002Co-Authors: Pamela Flood, Kristen CoatesAbstract:BACKGROUND Droperidol is used in neuroleptanesthesia and as an antiemetic. Although its antiemetic effect is thought to be caused by dopaminergic inhibition, the mechanism of Droperidol's anesthetic action is unknown. Because gamma-aminobutyric acid type A (GABAA) and neuronal nicotinic acetylcholine receptors (nAChRs) have been implicated as putative targets of other general anesthetic drugs, the authors tested the ability of Droperidol to modulate these receptors. METHODS gamma-Aminobutyric acid type A alpha1beta1gamma2 receptor, alpha7 and alpha4beta2 nAChRs were expressed in Xenopus oocytes and studied with two-electrode voltage clamp recording. The authors tested the ability of Droperidol at concentrations from 1 nm to 100 microm to modulate activation of these receptors by their native agonists. RESULTS Droperidol inhibited the GABA response by a maximum of 24.7 +/- 3.0%. The IC50 for inhibition was 12.6 +/- 0.47 nm Droperidol. At high concentrations, Droperidol (100 microm) activates the GABAA receptor in the absence of GABA. Inhibition of the GABA response is significantly greater at hyperpolarized membrane potentials. The activation of the alpha7 nAChR is also inhibited by Droperidol, with an IC50 of 5.8 +/- 0.53 microm. The Hill coefficient is 0.95 +/- 0.1. Inhibition is noncompetitive, and membrane voltage dependence is insignificant. CONCLUSIONS Droperidol inhibits activation of both the GABAA alpha1beta1gamma2 and alpha7 nAChR. The submaximal GABA inhibition occurs within a concentration range such that it might be responsible for the anxiety, dysphoria, and restlessness that limit the clinical utility of high-dose Droperidol anesthesia. Inhibition of the alpha7 nAChR might be responsible for the anesthetic action of Droperidol.
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Droperidol suppresses spontaneous electrical activity in neurons cultured from ventral midbrain: Implications for neuroleptanesthesia
Brain Research, 2000Co-Authors: Eric J. Heyer, Pamela FloodAbstract:Abstract Droperidol is used in anesthesia as an antiemetic and as a component in neuroleptanalgesia. Its mechanism of action is thought to involve dopamine receptor blockade in the brain. The electrophysiological consequences associated with this action however, have not been elucidated. In this study we demonstrate a dose-dependent electrophysiological response to Droperidol in central nervous system (CNS) neurons that express dopamine receptors that is absent in CNS neurons that do not express dopamine receptors. Primary dissociated cell (PDC) cultures were prepared from embryonal tissue dissected from ventral mesencephalon (VM) and spinal cord (SC). VM neurons were used to investigate the electrophysiological action of Droperidol, a dopamine receptor antagonist, since these cultures contain neurons having dopamine receptors on their surface. SC neurons were used as a control as they do not express dopamine receptors. Some dopamine receptors are on dopaminergic neurons and therefore are called autoreceptors, while others are on nondopaminergic neurons, such as GABA producing (GABAergic) neurons. All neurons in both PDC cultures were spontaneously active. The percentage of neurons which spontaneously generated action potentials was reduced in a dose-dependent manner by Droperidol (1 nM–10 μM) only in PDC cultures of VM. Exposure to Droperidol had no effect on neurons from PDC cultures of SC which lack dopamine receptors. Our results suggest that Droperidol modulates the electrophysiological properties of VM neurons with dopamine receptors possibly through facilitation of inhibitory interneurons. The reduced activity of VM neurons might contribute to the antiemetic and/or anesthetic activity of Droperidol, since the concentrations of Droperidol used in this study are at clinically relevant concentrations.
Jonathan Karro - One of the best experts on this subject based on the ideXlab platform.
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intravenous midazolam Droperidol combination Droperidol or olanzapine monotherapy for methamphetamine related acute agitation subgroup analysis of a randomized controlled trial
Addiction, 2017Co-Authors: Celene Y. L. Yap, Simone E Taylor, Georgina A Phillips, Jonathan Karro, David C M Kong, Jonathan C Knott, Esther W Chan, David Taylor, David CastleAbstract:Aim To examine the efficacy and safety of (1) midazolam–Droperidol versus Droperidol and (2) midazolam–Droperidol versus olanzapine for methamphetamine-related acute agitation. Design and setting A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Participants Three hundred and sixty-one patients, aged 18–65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Intervention and comparator Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg–Droperidol 5 mg combined, Droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, Droperidol 5 mg or olanzapine 5 mg, respectively. Measurements The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. Findings The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam–Droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the Droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02–21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74–19.33]. The number of patients who experienced an adverse event (AE) in the midazolam–Droperidol, Droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. Conclusion A midazolam–Droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than Droperidol or olanzapine alone.
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Intravenous midazolam–Droperidol combination, Droperidol or olanzapine monotherapy for methamphetamine‐related acute agitation: subgroup analysis of a randomized controlled trial
Addiction (Abingdon England), 2017Co-Authors: Celene Y. L. Yap, Simone E Taylor, Jonathan Karro, David C M Kong, Jonathan C Knott, Esther W Chan, David Taylor, Georgina Phillips, David CastleAbstract:To examine the efficacy and safety of (1) midazolam-Droperidol versus Droperidol and (2) midazolam-Droperidol versus olanzapine for methamphetamine-related acute agitation. A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Three hundred and sixty-one patients, aged 18-65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg-Droperidol 5 mg combined, Droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, Droperidol 5 mg or olanzapine 5 mg, respectively. The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam-Droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the Droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02-21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74-19.33]. The number of patients who experienced an adverse event (AE) in the midazolam-Droperidol, Droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. A midazolam-Droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than Droperidol or olanzapine alone. © 2017 Society for the Study of Addiction.
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Midazolam-Droperidol, Droperidol, or olanzapine for acute agitation: a randomized clinical trial
Annals of emergency medicine, 2016Co-Authors: David Taylor, Celene Y. L. Yap, Simone E Taylor, Jonathan Karro, David C M Kong, Jonathan C Knott, Esther W Chan, Georgina Phillips, David CastleAbstract: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.
