Safety of Intravenous Sedative Agents Used in the Management of Acute Psychiatric Emergencies: A Systematic Review

Background: Acute psychiatric emergencies require intravenous sedation when agitation prevents safe assessment and treatment. Rapid calming requires attention to clinically important respiratory, cardiovascular, and neurological adverse effects and associated clinical consequences. This review evaluated the safety of intravenous sedatives used for acute agitation, including evidence relevant to psychiatric emergency practice. Methods: Original studies published by 31/05/2026 were examined in a narrative synthesis. Intravenous findings were distinguished from intramuscular results, and overlapping publications were identified. Randomized comparisons were considered alongside observational safety cohorts, with mixed diagnostic populations interpreted as indirect data. Results: Nine original reports represented eight underlying studies. Droperidol produced more sustained sedation than lorazepam, while midazolam provided faster early sedation in another randomized comparison. Active airway management occurred in three midazolam recipients in that trial. Adding droperidol or olanzapine to midazolam shortened sedation time without a statistically detected increase in overall adverse events. Intravenous olanzapine cohorts reported respiratory depression, hypoxia, and hypotension, with differences in outcome definitions and denominators. Evidence did not establish a consistently safest regimen. Conclusions: Respiratory compromise and hemodynamic instability remain central safety concerns during intravenous management of acute agitation. Individualized treatment, repeated clinical assessment, physiological monitoring, and immediate airway support are essential in monitored settings, while conclusions specific to primary psychiatric diagnoses remain limited by heterogeneous study populations.