Torsades de Pointes Associated With Intravenous Haloperidol in Critically Ill Patients
Wayne State University, Detroit, Michigan, United States The American Journal of Cardiology
(Impact Factor: 3.28).
01/1998; 81(2):238-40. DOI: 10.1016/S0002-9149(97)00888-6
In this retrospective case-control study, 8 of 223 consecutive patients (3.6%) treated with intravenous haloperidol developed torsades de pointes, and were compared with 41 patients randomly selected as controls. The likelihood of torsades de pointes associated with intravenous haloperidol is significantly greater in patients receiving > or = 35 mg over 24 hours or in those with a QTc interval of >500 ms, or both.
Available from: Mojtaba Akbari
- "Haloperidol has a number of potential side effects namely akathesia, extrapyramidal symptoms, neuroleptic malignant syndrome, and cardiac arrhythmias. The risk of developing Torsades de Pointes is increased in patients receiving doses of 35 mg/d or higher. Haloperidol at doses 1-2 mg showed no significant effect of QT interval. "
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ABSTRACT: Haloperidol has an established role in nausea and vomiting prophylaxis and possible effects on multiple aspects of postoperative recovery including pain and sedation. The purpose of this study was to evaluate the effects of low-dose intraoperative intravenous haloperidol on quality of recovery (QoR) and pain control after general anesthesia and surgery.
Ninety eight American Society of Anesthesiologists (ASA) physical status I-II patients undergoing elective general, gynecologic or orthopedic surgery under general anesthesia were enrolled. Participants were randomly allocated to receive either haloperidol 2 mg or sterile water intravenously after induction of anesthesia. All patients were given elastometric morphine patient-controlled analgesia (PCA) pump for pain control after the surgery. Post-operative QoR was evaluated within 20 min in the recovery room and 6 h post-operatively. Pain intensity and demand for additional analgesic was measured in the 6(th) post-operative hour.
The QoR score in two measurements was not statistically different between the two groups. Haloperidol significantly reduced the nausea in the recovery. The visual analog scale pain score showed that the severity of pain in the haloperidol group was more than the placebo group (4.7 ± 2.4 vs. 3.8 ± 2.5, P = 0.05).
Intraoperative small-dose IV haloperidol is effective against post-operative nausea and vomiting with no significant effect on overall QoR. It may also attenuate the analgesic effects of morphine PCA.
Available from: Mark Van den Boogaard
- "In nine patients haloperidol was stopped because of prolonged QTc-time, which was probably due to the immediate start of haloperidol in the post-cardiopulmonary resuscitation phase after ICU admission combined with mild therapeutic hypothermia  in all nine patients. Moreover, QTc-time was only marginally prolonged and none of these patients developed ventricular arrhythmia, as reported in some case reports [36-39], or other tachyarrhythmias. Furthermore, in several patients, haloperidol dose was adjusted for reasons of drowsiness or a possible sedative effect. "
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ABSTRACT: INTRODUCTION: Delirium is associated with increased morbidity and mortality. We implemented a delirium prevention policy in intensive care unit (ICU) patients with a high risk to develop delirium, and evaluated if our policy resulted in quality improvement of relevant delirium outcome measures. METHODS: A before/after evaluation of a delirium prevention project using prophylactic treatment with haloperidol. Patients with a predicted risk for delirium of [greater than or equal to]50%, or with a history of alcohol abuse or dementia, were identified. According to the prevention protocol these patients received haloperidol 1mg/8hrs. Evaluation was primarily focused on delirium incidence, delirium free days without coma and 28-day mortality. Results of prophylactic treatment were compared with a historical control group and a contemporary group that did not receive haloperidol prophylaxis mainly due to non-compliance to the protocol mostly during the implementation phase. RESULTS: In 12 months 177 patients received haloperidol prophylaxis. Except for sepsis, patient characteristics were comparable between the prevention and the historical (N=299) group. Predicted chance to develop delirium was 75+/-19% and 73+/-22%, respectively. Haloperidol prophylaxis resulted in a lower delirium incidence (65% vs. 75%, p=0.01), and more delirium-free-days (median 20 days [IQR 8-27] vs. median 13 days [3-27], p=0.003) in the intervention group compared to the control group. Cox-regression analysis adjusted for sepsis showed a hazard rate of 0.80 (95% confidence interval 0.66-0.98) for 28-day mortality. Beneficial effects of haloperidol appeared most pronounced in the patients with the highest risk for delirium. Furthermore, haloperidol prophylaxis resulted in less ICU re-admissions (11% vs. 18%, p=0.03) and unplanned removal of tubes/lines (12% vs. 19%, p=0.02). Haloperidol was stopped in 12 patients because of QTc-time prolongation (n=9), renal failure (n=1) or suspected neurological side-effects (n=2). No other side-effects were reported. Patients who were not treated during the intervention period (N=59) showed similar results compared to the untreated historical control group. CONCLUSIONS: Our evaluation study suggests that prophylactic treatment with low dose haloperidol in critically ill patients with a high risk for delirium probably has beneficial effects. These results warrant confirmation in a randomized controlled trial. Trial registration: clinicaltrial.gov Identifier: NCT01187667.
Available from: François G Brivet
- "L'halopéridol présente les effets indésirables habituels de cette classe médicamenteuse (syndrome extrapyramidal , allongement de l'intervalle QT, syndrome malin des neuroleptiques, entre autres). L'incidence de survenue pour cette molécule est élevée et la gravité potentiellement très sévère  . La littérature sur les antipsychotiques atypiques intéressant les patients de réanimation est peu abondante. "
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ABSTRACT: Delirium in intensive care unit occurs frequently and carries an important prognostic significance. Its diagnostic has to rely on validated tools in the setting of a systematic approach, which allowed physicians to distinguish it from agitation and withdrawal syndrome. The identification of some risk factors leads to important therapeutic implications, among which goal-directed sedation protocols is essential. Sleep quality as well as early mobilisation of the patients may also impact the occurrence of delirium. Pharmacologic therapeutic approach relies mainly on antipsychotic drugs. Haloperidol is the most widely used molecule in that indication but other antipsychotic drugs seem to have less side effects. New drugs such as dexmetedimidine are promising, but have to be confirmed on larger studies.
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