Does low-dose droperidol increase the risk of polymorphic ventricular tachycardia or death in the surgical patient?

Abstract

BACKGROUND:

The Food and Drug Administration issued a black box warning regarding the use of droperidol and the potential for torsade de pointes.

METHODS:

The primary objective of this retrospective study was to determine if low-dose (0.625 mg) droperidol administration was associated with episodes of torsade de pointes in the general surgical population during the 3-yr period following the reinstitution of droperidol to our institutional formulary.

RESULTS:

The authors identified 20,122 surgical patients who received 35,536 doses of droperidol. These patients were cross-matched with an electrocardiogram database and an adverse outcome database. The charts of 858 patients were reviewed, including patients with documentation of prolonged QTc (>440 ms) from March 2007 to February 2011, polymorphic ventricular tachycardia (VT) within 48 h of receiving droperidol, or death within 7 days of receiving droperidol. Twelve surgical patients had VT (n = 4) or death (n = 8) documented within 48 h of droperidol administration. No patients developed polymorphic VT or death due to droperidol administration (n = 0). The eight patients that died were on palliative care. The four patients with documented VT had previous cardiac conditions: two had pre-existing implantable cardiac defibrillators, three had episodes of VT before receiving droperidol, and another had pre-existing hypertrophic obstructive cardiomyopathy. The authors found 523 patients with a documented QTc >440 ms before receiving droperidol. No patients developed VT or death as a direct result of droperidol administration.

CONCLUSIONS:

Our evidence suggests that low-dose droperidol does not increase the incidence of polymorphic VT or death when used to treat postoperative nausea and vomiting in the surgical population.

• Authors: Gregory A Nuttall, Ann M Malone, Carrie A Michels, Laurie C Trudell, Tricia D Renk, Mary E Shirk Marienau, William C Oliver, Michael J Ackerman
• Journal: Anesthesiology (Anesthesiology) Vol. 118 Issue 2 Pg. 382-6 (Feb 2013) ISSN: 1528-1175 [Electronic] United States
• PMID: 23291623 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antiemetics
• Droperidol

Topics

• Adult
• Aged
• Aged, 80 and over
• Antiemetics (administration & dosage, adverse effects, therapeutic use)
• Databases, Factual
• Droperidol (administration & dosage, adverse effects, therapeutic use)
• Electrocardiography (drug effects)
• Female
• Heart Diseases (complications)
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Postoperative Nausea and Vomiting (prevention & control)
• Retrospective Studies
• Surgical Procedures, Operative (mortality)
• Tachycardia, Ventricular (chemically induced, epidemiology, mortality)
• Torsades de Pointes (chemically induced, epidemiology, mortality)