For Rapid Sedation of the Agitated Patient, Consider Midazolam

Agitated patients often require sedation, but what is the best medication? Investigators conducted a prospective observational study in which all patients in one emergency department who required intramuscular sedation for agitation were treated with a particular agent during a 3-week period; after 15 weeks, five agents (haloperidol 5 mg, haloperidol 10 mg, ziprasidone 20 mg, olanzapine 10 mg, and midazolam 5 mg) had been used and average patient responses were compared.

Results from 737 encounters revealed midazolam to be the best agent, with 71% of patients adequately sedated at 15 minutes, versus 40% for haloperidol 5 mg, 42% for haloperidol 10 mg, 52% for ziprasidone, and 61% for olanzapine. However, 40% of the midazolam patients require…