Chemical restraints for the agitated, violent, or psychotic pediatric patient in the emergency department: controversies and recommendations.

PURPOSE OF REVIEW: Chemical restraint in the pediatric patient is an evolving clinical practice. Although a rare occurrence, chemically restraining a child may be necessary for the child's safety, healthcare worker's safety, and to expedite the medical evaluation. The purpose of this manuscript to review the definition and indications for chemical restraints, specific classes of drugs used for chemical restraints, and the legal implications associated with chemical restraints.

RECENT FINDINGS: Three classes of drugs will be reviewed: benzodiazepines, neuroleptics, and atypical antipsychotics, including side effects, dosages, and routes of administration. There are controversies surrounding some of these drugs. Very few recent studies have focused this topic on the pediatric patient. A recently published practice parameter will be reviewed that addresses the prevention and management of aggressive behavior in children and adolescents. In addition, specific studies looking at different drugs, particularly the newer atypical antipsychotics, will be reviewed. Literature discussing the controversies regarding droperidol usage in the emergency department will also be highlighted.

SUMMARY: The differential diagnosis for the agitated, violent, or psychotic patient is extensive and must be taken into consideration when deciding to use chemical restraints. When the decision is made to use chemical restraints, healthcare workers should be aware of the pharmacologic options as well as the complications associated with the agents.