medical restraint
Medical restraints are physical restraints used during certain medical procedures to restrain patients with (supposedly) the minimum of discomfort and pain and to prevent them from injuring themselves or others.
Rationale
There are many kinds of ...
in which a
drug
A drug is any chemical substance other than a nutrient or an essential dietary ingredient, which, when administered to a living organism, produces a biological effect. Consumption of drugs can be via insufflation (medicine), inhalation, drug i ...
is used to restrict the freedom or movement of a patient or in some cases to
sedate
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, ...
the patient. Chemical restraint is used in
emergency
An emergency is an urgent, unexpected, and usually dangerous situation that poses an immediate risk to health, life, property, or environment and requires immediate action. Most emergencies require urgent intervention to prevent a worsening ...
psychiatric
Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental conditions. These include matters related to cognition, perceptions, mood, emotion, and behavior.
Initial psychiatric assessment of ...
settings to perform
surgery
Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...
or to reduce agitation, aggression or violent behaviours; it may also be used to control or punish unruly behaviours. A drug used for chemical restraint may also be referred to as a " psychopharmacologic agent", " psychotropic drug" or "therapeutic restraint" in certain legal writing.
In the UK,
NICE
Nice ( ; ) is a city in and the prefecture of the Alpes-Maritimes department in France. The Nice agglomeration extends far beyond the administrative city limits, with a population of nearly one millionacute behaviour disturbances (ABD), but only after verbal calming and de-escalation techniques have been attempted. It is viewed as superior to physical restraint, with physical restraints only being recommended for the administration of a chemical restraint.
In the
United States
The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
, no drugs are presently approved by the
U.S. Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...
(FDA) for use as chemical restraints. Drugs that are often used as chemical restraints include
antipsychotics
Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizo ...
,
benzodiazepines
Benzodiazepines (BZD, BDZ, BZs), colloquially known as "benzos", are a class of central nervous system (CNS) depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat co ...
ketamine
Ketamine is a cyclohexanone-derived general anesthetic and NMDA receptor antagonist with analgesic and hallucinogenic properties, used medically for anesthesia, depression, and pain management. Ketamine exists as its S- (esketamine) a ...
. A systematic review in 2019 advised the use of intravenous
haloperidol
Haloperidol, sold under the brand name Haldol among others, is a typical antipsychotic medication. Haloperidol is used in the treatment of schizophrenia, tics in Tourette syndrome, mania in bipolar disorder, delirium, agitation, acute psychos ...
(a short half-life, first-generation antipsychotic) alone or in conjunction with
lorazepam
Lorazepam, sold under the brand name Ativan, Tavor among others, is a benzodiazepine medication. It is used to treat anxiety (including anxiety disorders), insomnia, severe agitation, active seizures including status epilepticus, alcoh ...
or
midazolam
Midazolam, sold under the brand name Versed among others, is a benzodiazepine medication used for anesthesia, premedication before surgical anesthesia, and procedural sedation, and to treat psychomotor agitation, severe agitation. It induces ...
(short half-life benzodiazepines), but said more research was needed.
Chemical restraint is sometimes misused by health care workers for the convenience of the staff rather than the benefit of the patient, for example to prevent patients from resisting care, rather than improving the health of the patient; it can cause more confusion in patients, slowing their recovery; and it can be unclear whether drugs used for chemical restraint are necessary to treat an underlying mental health condition or whether they are being used to sedate the patient. Patients can view chemical restraint as a violation of integrity and find the experience traumatic.
A
Human Rights Watch
Human Rights Watch (HRW) is an international non-governmental organization that conducts research and advocacy on human rights. Headquartered in New York City, the group investigates and reports on issues including War crime, war crimes, crim ...
report on the use of chemical restraints amongst the elderly in the US concluded that antipsychotic drugs are sometimes used almost by default to control difficult-to-manage residents. The FDA estimates 15,000 elderly individuals in nursing homes die each year due to the unnecessary use of antipsychotics. According to the Nursing Home Reform Act, individuals have the right to be free from physical or chemical restraints imposed for discipline or convenience and unnecessary to treat the resident's medical symptoms.