Practical guide to palliative sedation

Abstract

Terminally ill patients want assurance that their symptoms will be controlled as death approaches. Most patients can have a peaceful death with standard palliative care. Some patients approaching death, however, have refractory symptoms such as pain, dyspnea, nausea, and agitated delirium. Palliative sedation (PS), the use of medications to induce sedation in order to control refractory symptoms near death, is a therapeutic option for these patients. The reported frequency of PS use varies greatly, ranging from 5% to 52% of the terminally ill. One concern with PS is its effect on survival. Data suggest that PS does not lead to immediate death, with the median time to death after initiating PS being greater than 1 to 5 days. A number of medications have been used for PS, but midazolam is most commonly reported. PS is distinct from euthanasia because the intent of PS is relief from suffering without death as a required outcome.

Deletion of vanilloid receptor 1_expressing primary afferent neurons for pain control

“…Some patients with cancer have pain that is refractory to conventional medical therapies including opioid analgesia, and many of them experience aversive, dose-limiting side effects. Despite more than 100 years of searching for new pharmacological modalities to treat severe pain (4)(5)(6), only very few have emerged, and the current alternatives to opioids are nonselective chemical or surgical neuroablative interventions and palliative sedation (7)(8)(9). Both options are unsatisfactory, however.…”

Ist terminale Sedierung medizinisch sinnvoll oder ersetzbar?

“…Besonders in der angelsächsischen Literatur nimmt dieser Aspekt unter der Doktrin des Doppeleffektes einen großen Raum in der medizin-ethischen Diskussion ein [1]. Es muss jedoch angemerkt werden, dass die lege artis durchgeführte Analgosedierung bei sterbenden Palliativpatienten eine deutlich geringere Patientengefährdung darstellt, als manche diesbezüglichen Veröffentlichungen glauben machen [5]. Die klinische Verlaufskontrolle unter Berücksichtigung des Bewusstseinszustands, des kardiozirkulatorischen Systems und der Atmung gewährleis-tet eine hohe Patientensicherheit.…”

Effect of the Sedative Combination of Ketamine, Morphine and Midazolam on the Quality-of-Life in the Final Days of Terminally Ill Cancer Patients

“…Notably, some studies have shown that administration of some traditional palliative drugs (e.g., opiates) did not have a significant impact on life expectancy [7][8][9]. One of the most common combinations of first-line sedation in oncology is morphine plus midazolam.…”