• D Schwerthöffer and F-G Pajonk.
• Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU-München, Ismaningerstraße 22, 81675, München, Deutschland. dirk.schwerthoeffer@mri.tum.de.
• Anaesthesist. 2019 Feb 1; 68 (2): 83-89.

BackgroundAgitation is a frequent reason for emergency physician calls in psychiatric emergencies in the German preclinical emergency medical system. Benzodiazepines have proven to be effective in treating acute agitation. Although lorazepam has beneficial clinical and pharmacological properties it is hardly used by emergency physicians. The sublingual administration of lorazepam has many advantages compared to intravenous administration.Material And MethodsIn an interventional trial lasting 18 months the efficacy, tolerance and onset of effects of sublingual and intravenous lorazepam in patients with agitation states in emergency duties were compared. The randomization to the intervention groups was subject to a time criterion. The sublingual administration of lorazepam over a period of 9 months was followed by an intravenous administration over the same period of time. The psychometric scales used were: PANSS-EC, CGI, CGI-Change, agitation-calmness evaluation scale, visual analog scale and sedation scale. Response to the intervention was defined by a 40% reduction on the PANSS-EC scale.ResultsA total of 37 individuals participated in the study (sublingual: n = 22, intravenous: n = 15). Lorazepam was effective in treating acute agitation. The effectiveness and tolerance of sublingual and intravenous lorazepam administration seems to be comparable.ConclusionSublingual administration of lorazepam is effective for treating acute agitation in emergency medical services.

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