A comparison of the use of sedatives in a hospital support team and in a hospice

Abstract

This study examines how frequently and for what indications sedatives are prescribed in a hospital support team and in a hospice. We also looked at the survival of sedated patients from the date of admission and from the start of sedation. Overall 26% of patients were prescribed sedatives in order to sedate them (31% at the hospice and 21% at the hospital) and 43% of patients were given sedatives for symptom control (67% at the hospice and 21% at the hospital). Sedated patients survived for a mean of 1.3 days after the start of sedation, and there was no detectable difference in survival from the date of admission between sedated and nonsedated patients.

Palliative sedation: Nurses’ perceptions

“…The current literature refers to palliative sedation as terminal sedation and has focused on defining it, determining how often refractory symptoms occur in patients with advanced cancer, and discussion of the types of medications used to induce sedation (Chater, et a1., 1998;Cherny & Portenoy, !994;Fainsinger, Miller, Bruera, Hanson & Maceachern, 1991;Green & Davis, 1991; Morita, Inoue & Chihara, 1996; stone, Phillips, spruyt & waight, 1997;Ventafridda, Ripamonti, Deconno, Tamburini & Cassileth, 1990 (Bonica, 1985;Daut & Cleeland , lg82 (Bruera, Chadwick, Weinlick & Macdonald, 1987;Lawlor, Fainsinger, Bruera, 2000;Massie, Holland & Glass, 1983). Furthermore, in a canadian survey ofcancer patients (n:913), 94 % ofrespondents reported L 4 experiencing more than one symptom (Ashbury,Findlay,Reynolds & McKerracher,1g98).…”

Nem daganatos, krónikus progresszív betegségek palliatív ellátása

“…Napjainkban is megtapasztalható a súlyos dyspnoé-ban szenvedő betegek kezelését végző orvosok opioidok használatával szembeni aggodalma, azok légzésdepresz-sziót okozó hatása miatt. Azonban számos vizsgálat igazolta, hogy a nehézlégzés enyhítésére használt opioidok nem csökkentik a betegek élettartamát, nem ronják élet-kilátásaikat [22,23,24,25]. A 2. táblázat összefoglalja a fulladás tüneti kezelésére használható opioidok adagolá-sát és dózisát különböző súlyosságú és jellegű fulladás esetén opiátkezelésben még nem részesült és opiátot már használó betegek esetén.…”

Opioids for refractory dyspnea

“…Chan et al found that higher doses of opioids and anxiolytic medications used in withdrawal of life support were not associated with a decreased time from withdrawal of life support to death [67]. Other studies found that survival time after withdrawal of mechanical ventilation in the last week of life was unrelated to the dose of prescribed morphine [68][69][70]. Of numerous studies that provided information on oxygen saturation or arterial blood gases, only one investigation reported any changes in oxygenation with use of opioids [1].…”