Background: Acute behavioural disturbance (ABD) is a common problem in psychiatry and both physical restraint\r\nand involuntary parenteral sedation are often required to control patients. Although guidelines are available, clinical\r\npractice is often guided by experience and there is little agreement on which drugs should be first-line treatment\r\nfor rapid tranquilisation. This study aimed to investigate sedation for ABD in an acute mental healthcare unit,\r\nincluding the effectiveness and safety of high dose sedation.\r\nMethods: A prospective study of parenteral sedation for ABD in mental health patients was conducted from July\r\n2010 to June 2011. Drug administration (type, dose, additional doses), time to sedation, vital signs and adverse\r\neffects were recorded. High dose parenteral sedation was defined as greater than the equivalent of 10 mg\r\nmidazolam, droperidol or haloperidol (alone or in combination), compared to patients receiving 10 mg or less\r\n(normal dose). Effective sedation was defined as a fall in the sedation assessment tool score by two or a score of\r\nzero or less. Outcomes included frequency of adverse drug effects, time to sedation/tranquilisation and use of\r\nadditional sedation.\r\nResults: Parenteral sedation was given in 171 cases. A single drug was given in 96 (56%), including droperidol (74),\r\nmidazolam (19) and haloperidol (3). Effective sedation occurred in 157 patients (92%), and the median time to\r\nsedation was 20 min (Range: 5 to 100 min). The median time to sedation for 93 patients receiving high dose\r\nsedation was 20 min (5-90 min) compared to 20 min (5-100 min; p = 0.92) for 78 patients receiving normal dose\r\nsedation. Adverse effects occurred in 16 patients (9%); hypotension (14), oxygen desaturation (1), hypotension and\r\noxygen desaturation (1). There were more adverse effects in the high dose sedation group compared to the normal\r\ndose group [11/93 (12%) vs. 5/78 (6%); p = 0.3]. Additional sedation was given in 9 of 171 patients (5%), seven in\r\nthe high dose and two in the normal dose groups.\r\nConclusions: Large initial doses of sedative drugs were used for ABD in just over half of cases and additional\r\nsedation was uncommon. High dose sedation did not result in more rapid or effective sedation but was associated\r\nwith more adverse effects.
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