Midazolam sedation in palliative medicine: retrospective study in a French center for cancer control

Gamblin, Vincent; Berry, Vincent; Tresch-Bruneel, Emmanuelle; Reich, M.; Silva, Arlette Da; Villet, Stéphanie; Penel, Nicolas; Prod’homme, Chloé

doi:10.1186/s12904-020-00592-3

Cited by 9 publications

(7 citation statements)

References 40 publications

(60 reference statements)

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“…The predominance of midazolam in PS as well as the supplementation with drugs from other classes is common and in accordance with the international literature (Beller et al 2015;Gamblin et al 2020;Maltoni et al 2013Maltoni et al , 2012. Major differences in the sedation protocol between PCU and outpatient care were not detected.…”

Section: Discussionsupporting

confidence: 85%

Comparison of inpatient and outpatient palliative sedation practice – A prospective observational study

et al. 2022

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Introduction Palliative sedation (PS) is an intrusive measure to relieve patients at the end of their life from otherwise untreatable symptoms. Intensive discussion of the advantages and limitations of palliative care with the patients and their relatives should precede the initiation of PS since PS is terminated by the patient’s death in most cases. Drugs for PS are usually administered intravenously. Midazolam is widely used, either alone or in combination with other substances. PS can be conducted in both inpatient and outpatient settings; however, a quality analysis comparing both modalities was missing so far. Patients and methods This prospective observational study collected data from patients undergoing PS inpatient at the palliative care unit (PCU, n = 26) or outpatient at a hospice (n = 2) or at home (specialized outpatient palliative care [SAPV], n = 31) between July 2017 and June 2018. Demographical data, indications for PS, and drug protocols were analyzed. The depth of sedation according to the Richmond Agitation Sedation Scale (RASS) and the degree of satisfaction of staff members and patient’s relatives were included as parameters for quality assessment. Results Patients undergoing PS at the PCU were slightly younger compared to outpatients (hospice and SAPV combined). Most patients suffered from malignant diseases, and midazolam was the backbone of sedation for inpatients and outpatients. The median depth of sedation was between +1 and −3 according to the RASS with a trend to deeper sedation prior to death. The median degree of satisfaction was “good,” scored by staff members and by patient’s relatives. Significant differences between inpatients and outpatients were not seen in protocols, depth of sedation, and degree of satisfaction. Conclusion The data support the thesis that PS is possible for inpatients and outpatients with comparable results. For choosing the best place for PS, other aspects such as patient’s and relative’s wishes, stress, and medical reasons should be considered.

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Section: Discussionsupporting

confidence: 85%

Comparison of inpatient and outpatient palliative sedation practice – A prospective observational study

et al. 2022

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“…[19][20][21][22] The most widely used benzodiazepine-based sedative, MDZ, has a rapid onset, short active duration, and deep sedative effect, but it may lead to respiratory/circulatory depression. 13,23 Patients with terminal-stage cancer, particularly those with end-stage dyspnoea, have an increased risk of respiratory/ circulatory depression, and in our ward, we have already observed several instances of respiratory inhibition following MDZ-based palliative sedation. The highly selective α2-adrenergic agonist DEX simulates deep natural sleep by inducing a state similar to non-rapid eye movement sleep.…”

mentioning

confidence: 73%

Effect of Dexmedetomidine for Palliative Sedation for Refractory Dyspnoea in Patients with Terminal-Stage Cancer

Li¹,

Cui²,

Wang³

2023

CMAR

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Background Dyspnoea affects a considerable percentage of patients with terminal-stage cancer, and clinical guidelines recommend palliative sedation for patients with refractory dyspnoea. Midazolam is currently the most commonly used sedative; however, it can cause serious adverse reactions, such as respiratory/circulatory depression. Hence, there is a need for an alternative sedative. Dexmedetomidine (DEX) is a promising alternative as its “awake sedation” effect; however, little is known regarding its use in patients with end-stage dyspnoea. Therefore, the aim of this study was to determine the safety and usefulness of DEX for palliative sedation of patients with refractory dyspnoea. Methods This retrospective study included patients with terminal-stage cancer who received DEX for palliative sedation owing to refractory dyspnoea in the hospice ward from January 2018 to October 2022. We analysed their general data, dyspnoea conditions, sedation details, sedative treatment effect, dyspnoea relief, and changes in vital signs before and after sedation, via paired t -tests. Results We included 17 patients with terminal-stage cancer who received DEX palliative sedation at a dose of 0.2–0.9 µg/kg·h for refractory dyspnoea, among whom 6 (35%) received a loading dose of 1 µg/kg in 10 min. After 1 h of sedation and at the maximum sedation dose, the Respiratory Distress Observation Scale and Richmond Agitation-Sedation Scale scores decreased significantly compared with those before sedation (all P <0.001), as did the respiratory rate ( P =0.024 and P =0.008, respectively). The heart rate and blood oxygen saturation did not significantly change, whereas the systolic and diastolic blood pressure after 1 h of sedation were significantly lower than those before sedation (both P =0.015). Conclusion DEX is a promising palliative sedative for patients with terminal-stage cancer, as it safely relieved the symptoms of refractory dyspnoea without inducing serious adverse reactions. Therefore, DEX may greatly enhance the quality of life for patients with terminal-stage cancer.

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“…Inflammatory factors play an important role in acute cerebral infarction. The increase of CRP and TNF-α levels can aggravate the disease [18,19] . In this study, midazolam was given to the elderly patients with acute cerebral infarction for sedation.…”

Section: Resultsmentioning

confidence: 99%

Effect of Midazolam on Sedation and Hemorheology in Elderly Patients with Acute Cerebral Infarction

Ma¹,

Wen²

2021

ijps

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To explore the effect of midazolam in the treatment of senile acute cerebral infarction is the main objective. the patients were divided into observation group (n=55) and control group (n=55) by envelope method, the control group was given routine treatment, the observation group was given midazolam on the basis of the control group, the time required for sedation, mean arterial pressure, heart rate and so on were observed. There was no significant difference in sedation time between the observation group and the control group (p>0.05). The awakening time of the observation group was (8.10±1.54) min, which was significantly shorter than that of the control group (p<0.05). The mean arterial pressure and heart rate of the observation group before anesthesia induction (T1) and 30 min after anesthesia (T2) were ( 92.02±3.05) mmHg and (91.14±2.93) mmHg, (87.70±4.82) times/min and (83.02±5.01) times/min, respectively, which were significantly lower than those of the control group (p<0.05). The blood oxygen difference [D (a-jv) O 2 ] and cerebral oxygen uptake rate (ERO 2 ) at T1 and T2 in the observation group were (4.56±0.67) and (3.02±0.82), (20.20±6.73) % and (16.80±4.11) %, respectively, which were significantly lower than those in the control group (p<0.05). The scores of mini-mental state examination at 1 d and 3 d after operation in the observation group were (25.11±2.10) and (26.04±1.92), respectively, which were significantly higher than those in the control group (p<0.05). The serum C-reactive protein and tumor necrosis factor alpha in the observation group were significantly lower than those in the control group at 1 d, 3 d and 7 d after operation (p<0.05). Midazolam has a good sedative effect in the elderly patients with acute cerebral infarction, reducing brain oxygen metabolism and stabilizing hemorheology.

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Midazolam sedation in palliative medicine: retrospective study in a French center for cancer control

Cited by 9 publications

References 40 publications

Comparison of inpatient and outpatient palliative sedation practice – A prospective observational study

Comparison of inpatient and outpatient palliative sedation practice – A prospective observational study

Effect of Dexmedetomidine for Palliative Sedation for Refractory Dyspnoea in Patients with Terminal-Stage Cancer

Effect of Midazolam on Sedation and Hemorheology in Elderly Patients with Acute Cerebral Infarction

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