Palliative Sedation in the Control of Refractory Symptoms

Rousseau, Paul

doi:10.1089/jpm.2005.8.10

Cited by 40 publications

(50 citation statements)

References 14 publications

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“…29,60,68,90,[109][110][111][112][113][114][115][116][117] The concurrent use of antipsychotic medications targeted at perceptual disturbances or delusions may also be warranted.…”

Section: Irreversible Hyperactive Deliriummentioning

confidence: 99%

“…[47][48][49][50][51] In dying patients with hyperactive delirium, when the goals are to decrease agitation, relieve muscle tension, ensure amnesia, and minimize the risk of seizures, benzodiazepines appear to be ideal medications to manage and prevent these symptoms. 29,60,68,90,[109][110][111][112][113][114][115][116][117]119 Benzodiazepines. These function as sedatives, anxiolytics, skeletal muscle relaxants, amnestics, and potent antiepileptics (Table 3).…”

Section: Muscle Relaxation Anticonvulsantmentioning

confidence: 99%

“…The dose of a benzodiazepine typically needed to control the symptoms of delirium is far below their median lethal dosages (LD 50 ; see Table 4). 93,110 If a paradoxical reaction occurs and the patient becomes more agitated, safe and rapid titration to higher doses will usually overcome the paradoxical reaction and palliate the symptoms. Target doses are still the minimum needed to effectively relieve distressing symptoms without any unwanted side effects.…”

Section: Muscle Relaxation Anticonvulsantmentioning

confidence: 99%

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Clarifying Delirium Management: Practical, Evidenced-Based, Expert Recommendations for Clinical Practice

Irwin

Pirrello

Hirst

et al. 2013

Journal of Palliative Medicine

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Delirium is highly prevalent in those with serious or advanced medical illnesses. It is associated with many adverse consequences, including significant patient, family, and health care provider distress. This article suggests a novel approach to delirium assessment and management and provides useful, practical guidance for clinicians based on a complete review of the existing literature and the expert clinical opinion of the authors and their colleagues, derived from over a decade of collective bedside experience. Comprehensive assessment includes careful description of observed symptoms, signs, and behaviors; and an understanding of the patient's situation, including primary diagnosis, associated comorbidities, functional status, and prognosis. The importance of incorporating goals of care for the patient and family is discussed. The concepts of potential reversibility versus irreversible delirium and delirium subtype are proffered, with a description of how diagnostic and management strategies follow from these concepts. Pharmacological interventions that provide rapid, effective, and safe relief are presented. Employing both pharmacological and nonpharmacological interventions, including patient and family education, improves symptoms and relieves patient and family distress, whether the delirium is reversible or irreversible, hyperactive or hypoactive. All interventions can be provided in any setting of care, including patients' homes.

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“…29,60,68,90,[109][110][111][112][113][114][115][116][117] The concurrent use of antipsychotic medications targeted at perceptual disturbances or delusions may also be warranted.…”

Section: Irreversible Hyperactive Deliriummentioning

confidence: 99%

Section: Muscle Relaxation Anticonvulsantmentioning

confidence: 99%

Section: Muscle Relaxation Anticonvulsantmentioning

confidence: 99%

See 1 more Smart Citation

Clarifying Delirium Management: Practical, Evidenced-Based, Expert Recommendations for Clinical Practice

Irwin

Pirrello

Hirst

et al. 2013

Journal of Palliative Medicine

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“…The sub-themes are discussed in the light of Diego Gracia's 8,9 contributions to bioethics applied in medical practice and of other scholars of the subject 10 , as well as of researchers whose works focus on the practice of palliative sedation in palliative care [5][6][7] .…”

Section: Resultsmentioning

confidence: 99%

“…Several authors, such as Maltoni et al 5 and Chiu et al 6 , argue that palliative sedation, including continuous sedation until the time of death, does not aim to shorten or prolong life, but to alleviate suffering. It consists of conduct that leads to a reduction of consciousness, from mild to profound, temporary or permanent, but not deliberately causing the death of subjects affected by disease at an advanced stage, in the final phase of life and with specific refractory symptoms 7 , palliative sedation is highly recommended in the practice of palliative care provided by multidisciplinary teams.…”

mentioning

confidence: 99%

Deliberação moral em sedação paliativa para uma equipe de cuidados paliativos oncológicos

2015

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The aim of this study was to understand how a palliative care team seeks solutions for ethical conflicts related to deep palliative sedation in everyday care and whether the discussions and the decisions that are made within the multidisciplinary team involve the sick person and his family. This is a descriptive exploratory qualitative study, based on dialectical hermeneutics. The research subjects were ten professionals on the health team of a hospital's Oncology Palliative Care department. The results indicate that a humanistic attitude assumes, among many things, the prudent use of palliative sedation as an available resource to minimize suffering during the process of dying. The practice of palliative sedation requires a thorough analysis of the clinical facts, ethical reflection by the multidisciplinary team, as well as respect for the values of the sick person and their family and their participation, which would result in a process of moral deliberation. Keywords: Deep sedation. Palliative care. Bioethics. Decision making. ResumoDeliberação moral em sedação paliativa para uma equipe de cuidados paliativos oncológicos O objetivo deste estudo foi compreender como uma equipe de cuidados paliativos busca soluções para os conflitos éticos relacionados à sedação paliativa, no cotidiano assistencial, e se as discussões e decisões são feitas e deliberadas em equipe multiprofissional, envolvendo também o sujeito doente e sua família. Trata-se de pesquisa exploratório-descritiva de abordagem qualitativa, com base analítica na hermenêutica dialética. Os participantes da pesquisa foram 10 profissionais que integram a equipe de saúde de um setor hospitalar de cuidados paliativos oncológicos. Os resultados indicam que uma assistência humanizada pressupõe, entre tantos aspectos, o uso prudente da sedação paliativa como recurso disponível para a minimização do sofrimento no processo de morrer. A prática da sedação paliativa requer análise minuciosa dos fatos clínicos, reflexão ética em equipe multiprofissional, assim como participação e respeito aos valores da pessoa doente e seus familiares, o que propiciaria um processo de deliberação moral. Palavras-chave: Sedação profunda. Cuidados paliativos. Bioética. Tomada de decisões. ResumenDeliberación moral en sedación paliativa destinada a un equipo de cuidados paliativos oncológicos El objetivo de este estudio fue comprender cómo un equipo de cuidados paliativos busca soluciones en la cotidianeidad de la asistencia para los conflictos éticos relacionados a la sedación paliativa y si las discusiones y decisiones son tomadas y deliberadas en el ámbito del equipo multiprofesional, englobando al sujeto enfermo y a su familia. Se trata de una investigación exploratoria-descriptiva de abordaje cualitativo, con base analítica en la hermenéutica dialéctica. Los sujetos de investigación fueron diez profesionales que integran el equipo de salud de un sector hospitalario de cuidados paliativos oncológicos. Los resultados indican que una asistencia humanizada presupone, entre m...

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Improving Prescription in Palliative Sedation

Hasselaar¹,

Reuzel²,

Verhagen³

et al. 2007

Arch Intern Med

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Background: Two guidelines addressing palliative sedation have been published in the Netherlands in 2002 and 2003. The objective of the present study is to determine adherence to the guidelines for palliative sedation with regard to prescription. The study is restricted to the practice of continuous deep palliative sedation. Methods: A structured retrospective questionnaire was administered to 1464 physicians concerning their last case of deep sedation during the past 12 months. Physicians included Dutch hospital specialists, general practitioners, and nursing home physicians. Results: The response rate was 36%. A total of 43% (95% confidence interval [CI], 37%-49%) of the responding physicians did not adhere to the guidelines. Sources of deviation were the use of basic medication other than a benzodiazepine (30%), which mostly involved morphine, and omissions in adjuvant medication (13%). Nonsignificant positive association was found for consultation of a palliative care expert (odds ratio [OR], 3.86; 95%

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Palliative Sedation in the Control of Refractory Symptoms

Cited by 40 publications

References 14 publications

Clarifying Delirium Management: Practical, Evidenced-Based, Expert Recommendations for Clinical Practice

Clarifying Delirium Management: Practical, Evidenced-Based, Expert Recommendations for Clinical Practice

Deliberação moral em sedação paliativa para uma equipe de cuidados paliativos oncológicos

Improving Prescription in Palliative Sedation

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