Droperidol

INTRODUCTION

Indications

used to produce tranquilization and as an adjunct to general and regional anesthesia. Unlabeled Use: useful in decreasing postoperative or postprocedure nausea and vomiting.

Action

Similar to haloperidol—alters the action of dopamine in the CNS. Therapeutic Effects: Tranquilization. Suppression of nausea and vomiting in selected situations.

Adverse Reactions/Side Effects

CNS: SEIZURES, extrapyramidal reactions, abnormal EEG, anxiety, confusion, dizziness, excessive sedation, hallucinations, hyperactivity, mental depression, nightmares, restlessness, tardive dyskinesia. CV: ARRHYTHMIAS (INCLUDING TORSADES DE POINTES), QT prolongation. EENT: blurred vision, dry eyes. Resp: bronchospasm, laryngospasm. CV: hypotension, tachycardia. GI: constipation, dry mouth. Misc: chills, facial sweating, shivering.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess motor function, and be alert for extrapyramidal symptoms. Report these symptoms immediately, especially tardive dyskinesia, because this problem may be irreversible. Common extrapyramidal symptoms include:

  • Tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities, lip smacking or puckering, puffing of cheeks, uncontrolled chewing, rapid or worm-like movements of tongue).

  • Pseudoparkinsonism (shuffling gait, rigidity, tremor, pill-rolling motion, loss of balance control, difficulty speaking or swallowing, mask-like face).

  • Akathisia (restlessness or desire to keep moving).

  • Other dystonias and dyskinesias (dystonic muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs).

• Assess blood pressure (BP) and report a symptomatic decrease in BP; that is, hypotension that results in dizziness and syncope.

• Assess symptoms of bronchospasm and laryngeal spasm, including wheezing, coughing, and tightness in the throat and chest. Perform pulmonary function tests as needed to quantify suspected changes in ventilation and respiration (See Appendices I, J, K).

• Monitor excessive sedation or changes in mood and behavior such as anxiety, confusion, restlessness, mental depression, nightmares, and hallucinations. Notify physician or nurse immediately if these changes become problematic.

• If used to control postoperative nausea and vomiting, monitor the frequency, severity, and duration of GI problems to help document drug effectiveness.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth) caused by drowsiness, blurred vision, or extrapyramidal symptoms; implement fall-prevention strategies (See Appendix E).

• Because of the risk of arrhythmias and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses ...