Dr. Anna Yaffee: 52 in 52: Chemical Restraint

Anna Yaffee

Recent articles 52 in 52:

Nobay et al. 2004. A prospective, double-blind, randomized trial of midazolam vs haloperidol vs lorazepam in the chemical restraint of violent and severely agitated patients. Acad Emerg Med. 11(7): 744-749.

Take home point:

In this double-blind, randomized trial of 111 violent and severely agitated patients in a county emergency department receiving one of three chemical restraint agents, midazolam was found to be most efficacious in terms of time to onset and arousal. Midazolam also has rapid IM absorption and predictable sedation levels. No adverse effects were noted in the patients receiving midazolam.

Midazolam 5mg IM: Mean Time to Sedation 18.3 min; Mean Time to Arousal 81.9 min

Haloperidol 5mg IM: Mean Time to Sedation 28.3 min; Mean Time to Arousal 126.5 min

Lorazepam 2mg IM: Mean Time to Sedation 32.2 min; Mean Time to Arousal 217.2 min


  1. Does anyone use droperidol regularly? How about geodon? I’ listened to an EMCRIT on it 5mg of Droperidol and 2 of versed IM or IV are safe and effective agents. Any thoughts?

    • Doug Krug MD on August 22, 2014 at 6:03 pm
    • Reply

    Didn’t realize Droperidol (Inapsine) on formulary. Used it regularly years ago before the Black Box warnings eliminated it from our armamentarium. Was great drug for intractable N/V and sedation.

    Geodon used regularly at Kennestone with (generally speaking) excellent results. Always concerned about shot gunning an unknown severely agitated, combative patient with a medication known to potentially prolong QTc without knowing patient’s electrolyte or QTc status. May be more theoretic than real, however, as I have not heard of any bad outcomes at Kennestone and we use it regularly.

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