title: Chemical agents for the sedation of agitated patients in the ED: a systematic review.
abstract: OBJECTIVE
  Chemical agents commonly used to sedate agitated patients in the emergency department include benzodiazepines, antipsychotics, or a combination of the 2 classes. Our objective was to determine if a class or combination therapy is (1) more effective, as measured by the proportion sedated at 15-20 minutes and the need for repeat sedation, and (2) safer, as measured by the proportion of reported adverse events.
  
  
  METHODS
  Systematic literature review and meta-analysis of studies comparing 2 or more chemical agents for sedation of agitated patients in the emergency department were carried out in PubMed, PsycINFO, Embase, and the Cochrane database. Meta-analyses for pairwise comparisons of drug class (benzodiazepine, antipsychotic, or combination) were carried out for each outcome: proportion sedated, need for repeat sedation, and adverse events.
  
  
  RESULTS
  Seven studies with 1135 patients were included. At 15-20 minutes, the proportion of patients sedated was greater with combination therapy than benzodiazepines alone (risk ratio [RR] = 1.31, P < .0001). Antipsychotics and combination agents required significantly less repeat sedations than benzodiazepines alone (RR = 0.49, P < .0001 and RR = 0.64, P = .002). There was significant heterogeneity in adverse event data, with respiratory system adverse events (desaturation, and need for airway and ventilatory support) being the most commonly reported. Benzodiazepines were associated with a higher incidence of adverse events than antipsychotics or combination therapy.
  
  
  CONCLUSIONS
  Combination therapy sedated a greater proportion of patients at 15-20 minutes than benzodiazepines alone. Antipsychotics and combination therapy were more effective, requiring less repeat doses for sedation than benzodiazepines. The risk of any adverse event was higher with benzodiazepines.
authors.affiliation: Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Viola
authors.initials: V
authors.lastname: Korczak
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Kirby
authors.affiliation: Westmead Hospital, Sydney, Australia; Discipline of Emergency Medicine, Sydney Medical School, University of Sydney, New South Wales, Australia. Electronic address: naren.gunja@sydney.edu.au.
authors.forename: Naren
authors.initials: N
authors.lastname: Gunja
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D011595:Psychomotor Agitation / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines