Gartenberg Ariella, Levine Kayla, Petrie Alexander
Department of Emergency Medicine, Jacobi Medical Center and Montefiore Medical Center, NY 10461, USA.
Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, NY 10461, USA.
World J Emerg Med. 2024;15(2):83-90. doi: 10.5847/wjem.j.1920-8642.2024.011.
Agitation is a common presentation within emergent departments (EDs). Agitation during pregnancy should be treated as an obstetric emergency, as the distress may jeopardize both the patient and fetus. The safety of psychotropic medications in the reproductive age female has not been well established. This review aimed to explore a summary of general agitation recommendations with an emphasis on ED management of agitation during pregnancy.
A literature review was conducted to explore the pathophysiology of acute agitation and devise a preferred treatment plan for ED management of acute agitation in the reproductive age or pregnant female.
While nonpharmacological management is preferred, ED visits for agitation often require medical management. Medication should be selected based on the etiology of agitation and the clinical setting to avoid major adverse effects. Adverse effects are common in pregnant females. For mild to moderate agitation in pregnancy, diphenhydramine is an effective sedating agent with minimal adverse effects. In moderate to severe agitation, high-potency typical psychotropics are preferred due to their neutral effects on hemodynamics. Haloperidol has become the most frequently utilized psychotropic for agitation during pregnancy. Second generation psychotropics are often utilized as second-line therapy, including risperidone. Benzodiazepines and ketamine have demonstrated adverse fetal outcomes.
While randomized control studies cannot be ethically conducted on pregnant patients requiring sedation, animal models and epidemiologic studies have demonstrated the effects of psychotropic medication exposure . As the fetal risk associated with multiple doses of psychotropic medications remains unknown, weighing the risks and benefits of each agent, while utilizing the lowest effective dose remains critical in the treatment of acute agitation within the EDs.
躁动是急诊科常见的症状表现。孕期躁动应作为产科急症来处理，因为这种不适可能危及孕妇和胎儿。精神类药物在育龄女性中的安全性尚未得到充分证实。本综述旨在探讨一般性躁动处理建议的概述，重点是孕期躁动在急诊科的处理。
进行文献综述，以探究急性躁动的病理生理学，并制定针对育龄期或孕期女性急性躁动在急诊科处理的首选治疗方案。
虽然首选非药物治疗，但因躁动到急诊科就诊的患者往往需要药物治疗。应根据躁动的病因和临床情况选择药物，以避免重大不良反应。不良反应在孕妇中很常见。对于孕期轻度至中度躁动，苯海拉明是一种有效的镇静剂，不良反应最小。对于中度至重度躁动，由于高效典型精神类药物对血流动力学的中性作用，故更为适用。氟哌啶醇已成为孕期治疗躁动最常用的精神类药物。第二代精神类药物常作为二线治疗药物使用，包括利培酮。苯二氮䓬类药物和氯胺酮已显示出不良胎儿结局。
虽然无法对需要镇静的孕妇进行符合伦理的随机对照研究，但动物模型和流行病学研究已证明了精神类药物暴露的影响。由于与多剂量精神类药物相关的胎儿风险仍然未知，在急诊科治疗急性躁动时，权衡每种药物的风险和益处，并使用最低有效剂量仍然至关重要。
