Safety of Intravenous Sedative Agents Used in the Management of Acute Psychiatric Emergencies: A Systematic Review

Authors

  • Abdullah Abdulaziz F Alhowidi Emergency Medicine Consultant, Emergency Department, Riyadh First Health Cluster, Riyadh, Saudi Arabia Author
  • Moayad Ahmed Tuhami Medical Intern, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia Author
  • Faisal Mansour Alrowili Medical intern, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Author
  • Feras Ramzi Alnufaily Medical intern, College of Medicine, king Faisal University, Al-Ahsa, Saudi Arabia Author
  • Ghala Khalid Alhathal Medical Intern, College of Medicine, Hail University, Hail, Saudi Arabia Author
  • Fahad Ayed Albaqami Medical intern, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Author
  • Dareen Ahmed Abdullah Medical Intern, College of Medicine, Jeddah University, Jeddah, Saudi Arabia Author
  • Rouz Abdulkader Banjar Medical intern, College of Medicine, Fakeeeh college for medical sciences, Jeddah, Saudi Arabia Author
  • Hamad Naif Alharbi Medical Intern, College of Medicine, Taibah University, Medina, Saudi Arabia. Author
  • Fahd Abdulaziz Aljohani Medical intern , College of Medicine, Jeddah University, Jeddah , Saudi Arabia. Author
  • Ghadah Khaled Alatawi Medical intern, College of Medicine, University of Tabuk, Tabuk , Saudi Arabia Author

DOI:

https://doi.org/10.65759/p0r6vf51

Keywords:

Acute agitation, psychiatric emergencies, intravenous sedation, droperidol, midazolam

Abstract

Background: Acute psychiatric emergencies require intravenous sedation when agitation prevents safe assessment and treatment. Rapid calming requires attention to clinically important respiratory, cardiovascular, and neurological adverse effects and associated clinical consequences. This review evaluated the safety of intravenous sedatives used for acute agitation, including evidence relevant to psychiatric emergency practice. Methods: Original studies published by 31/05/2026 were examined in a narrative synthesis. Intravenous findings were distinguished from intramuscular results, and overlapping publications were identified. Randomized comparisons were considered alongside observational safety cohorts, with mixed diagnostic populations interpreted as indirect data. Results: Nine original reports represented eight underlying studies. Droperidol produced more sustained sedation than lorazepam, while midazolam provided faster early sedation in another randomized comparison. Active airway management occurred in three midazolam recipients in that trial. Adding droperidol or olanzapine to midazolam shortened sedation time without a statistically detected increase in overall adverse events. Intravenous olanzapine cohorts reported respiratory depression, hypoxia, and hypotension, with differences in outcome definitions and denominators. Evidence did not establish a consistently safest regimen. Conclusions: Respiratory compromise and hemodynamic instability remain central safety concerns during intravenous management of acute agitation. Individualized treatment, repeated clinical assessment, physiological monitoring, and immediate airway support are essential in monitored settings, while conclusions specific to primary psychiatric diagnoses remain limited by heterogeneous study populations.

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Published

2026-10-28

Issue

Vol. 3 No. 04 (2026): Journal of Tazeez for Public Health

Section

Articles