I still would be interested in seeing a reference./
We use drop all the time but always at low doses, .625 mg.
Anesthesiology:
October 2007 - Volume 107 - Issue 4 - pp 524-526
doi: 10.1097/01.anes.0000282093.29212.b6
Editorial Views
Droperidol-induced Proarrhythmia: The Beginning of an Answer?
Charbit, Beny M.D.; Funck-Brentano, Christian M.D., Ph.D.
Free Access
Droperidol has several electrophysiologic characteristics that the guidelines view as potentially harmful. Droperidol blocks HERG, one of the main ionic currents that underlies QT interval duration.
4,5 Results of clinical evaluations are not consistent. White
et al.6 failed to demonstrate statistically significant QT interval prolongation with 1.25 mg droperidol. However, they found a 22-ms QT prolongation with droperidol compared with 12 ms with placebo, and their study was only powered to detect QTc change of 15% (
i.e., approximately 60 ms). In a study that was not placebo controlled, we found a 17-ms QT interval prolongation with 0.75 mg droperidol. Therefore, although not definitively proven or studied according to the guidelines,
droperidol can prolong the QT interval even at a low dose and belongs to the increasing list of noncardiac drugs for which some form of warning is justified.
Finally, if one considers the estimated maximal risk of droperidol-induced proarrhythmia (3.6 per 10,000), this would still represent a risk 60 times greater than that of epidural hematoma after epidural anesthesia, whose risk is approximately 1 in 168,000 in the United States.
12 Even if it is not fatal, no anesthesiologist worldwide would consider the risk of epidural hematoma negligible and accept to perform everyday epidural anesthesia without any caution. Therefore, although the precise format of the warning certainly remains a matter for debate,
the warning itself is still justified because one has to be more stringent on safety issues than on efficacy issues.
Beny Charbit, M.D.,
Christian Funck-Brentano, M.D., Ph.D.,
Université Pierre et Marie Curie-Paris 6, Department of Pharmacology; Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, Division of Clinical Pharmacology; Institut National de la Santé et de la Recherche Médicale (INSERM) CIC9304, Paris, France.
[email protected]
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References
1. Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S, Kovac A, Philip BK, Sessler DI, Temo J, Tramer MR, Watcha M: Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003; 97:62-71
Cited Here... |
View Full Text |
PubMed |
CrossRef
2. Nuttall GA, Eckerman KM, Jacob KA, Pawlaski EM, Wigersma SK, Shirk Marienau ME, Olivier WC, Narr BJ, Ackerman MJ: Does low-dose droperidol administration increase the risk of drug-induced QT prolongation and torsade de pointes in the general surgical population? Anesthesiology 2007; 107:531-6
Cited Here... |
View Full Text |
PubMed |
CrossRef
3. Roden DM: Drug-induced prolongation of the QT interval. N Engl J Med 2004; 350:1013-22
Cited Here... |
PubMed |
CrossRef
4. Drolet B, Zhang S, Deschenes D, Rail J, Nadeau S, Zhou Z, January CT, Turgeon J: Droperidol lengthens cardiac repolarization due to block of the rapid component of the delayed rectifier potassium current. J Cardiovasc Electrophysiol 1999; 10:1597-604
Cited Here... |
PubMed |
CrossRef
5. Schwoerer AP, Blutner C, Brandt S, Binder S, Siebrands CC, Ehmke H, Friederich P: Molecular interaction of droperidol with human ether-a-go-go-related gene channels: Prolongation of action potential duration without inducing early afterdepolarization. Anesthesiology 2007; 106:967-76
Cited Here... |
View Full Text |
PubMed |
CrossRef
6. White PF, Song D, Abrao J, Klein KW, Navarette B: Effect of low-dose droperidol on the QT interval during and after general anesthesia: A placebo-controlled study. Anesthesiology 2005; 102:1101-5
Cited Here... |
View Full Text |
PubMed |
CrossRef
7. Charbit B, Albaladejo P, Funck-Brentano C, Legrand M, Samain E, Marty J: Prolongation of QTc interval after postoperative nausea and vomiting treatment by droperidol or ondansetron. Anesthesiology 2005; 102:1094-100
Cited Here... |
View Full Text |
PubMed |
CrossRef
8. Pratt CM, Ruberg S, Morganroth J, McNutt B, Woodward J, Harris S, Ruskin J, Moye L: Dose-response relation between terfenadine (Seldane) and the QTc interval on the scalar electrocardiogram: Distinguishing a drug effect from spontaneous variability. Am Heart J 1996; 131:472-80
Cited Here... |
View Full Text |
PubMed |
CrossRef
9. Woosley RL, Chen Y, Freiman JP, Gillis RA: Mechanism of the cardiotoxic actions of terfenadine. JAMA 1993; 269:1532-6
Cited Here... |
PubMed |
CrossRef
10. Hanrahan JP, Choo PW, Carlson W, Greineder D, Faich GA, Platt R: Terfenadine-associated ventricular arrhythmias and QTc interval prolongation: A retrospective cohort comparison with other antihistamines among members of a health maintenance organization. Ann Epidemiol 1995; 5:201-9
Cited Here... |
PubMed |
CrossRef
11. Kuryshev YA, Brown AM, Wang L, Benedict CR, Rampe D: Interactions of the 5-hydroxytryptamine 3 antagonist class of antiemetic drugs with human cardiac ion channels. J Pharmacol Exp Ther 2000; 295:614-20
Cited Here... |
PubMed
12. Ruppen W, Derry S, McQuay H, Moore RA: Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia. Anesthesiology 2006; 105:394-9