• Gregory A Nuttall, Ann M Malone, Carrie A Michels, Laurie C Trudell, Tricia D Renk, Mary E Shirk Marienau, William C Oliver, and Michael J Ackerman.
• Mayo Clinic College of Medicine, Rochester, MN 55905, USA. nuttall.gregory@mayo.edu
• Anesthesiology. 2013 Feb 1;118(2):382-6.

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

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