Potential harms of pharmacological management for acute behavioural disturbance in adults
Pharmacological management for adults with acute behavioural disturbance can be associated with potential harms. If pharmacological management is used, consider seeking expert advice, and always monitor the patient closely for adverse drug effects; see Principles of monitoring patients with acute behavioural disturbance for more information.
Potential harms that are associated with sedative drugs include:
- oversedation
- airway obstruction
- loss of airway tone and protective reflexes
- laryngospasm
- respiratory depression
- QT-interval prolongation and arrhythmias
- aspiration
- hypotension
- falls
- complications of immobility (eg pressure injury)
- paradoxical agitation
- extrapyramidal adverse effects of antipsychotic drugs
- anticholinergic adverse effects of antipsychotic drugs.
Oversedation, causing unconsciousness and loss of protective airway reflexes, is an emergency—if this occurs, seek expert assistance to manage the airway and breathing urgently according to advanced life support protocols1. This is rare after oral sedative drug administration—complications are more likely after parenteral administration of sedative drugs.
Some patients have a higher risk of adverse effects after sedative drug administration, including:
- people with high levels of frailty
- older people (see separate topic on Pharmacological management for acute behavioural disturbance in older people)
- adults with the following
- severely limiting systemic disease
- morbid obesity
- obstructive sleep apnoea
- known or suspected difficult endotracheal intubation
- severe anaemia
- increased risk of aspiration of stomach contents
- previous adverse events associated with sedation, analgesia or anaesthesia
- concomitant sedative use.