title: 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.affiliation: Mayo Clinic College of Medicine, Rochester, MN 55905, USA. nuttall.gregory@mayo.edu
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nuttall
authors.forename: Ann M
authors.initials: AM
authors.lastname: Malone
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Michels
authors.forename: Laurie C
authors.initials: LC
authors.lastname: Trudell
authors.forename: Tricia D
authors.initials: TD
authors.lastname: Renk
authors.forename: Mary E Shirk
authors.initials: ME
authors.lastname: Marienau
authors.forename: William C
authors.initials: WC
authors.lastname: Oliver
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ackerman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016208:Databases, Factual; D004329:Droperidol / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006331:Heart Diseases / Q000150:complications; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality*; D017180:Tachycardia, Ventricular / Q000139:chemically induced* / Q000453:epidemiology* / Q000401:mortality; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000453:epidemiology* / Q000401:mortality
chemical_list: D000932:Antiemetics; D004329:Droperidol