Ketamine: Does It Have a Role in Palliative Sedation?

Carter, Michael J.; Gibbins, Jane; Senior-Smith, Gaye; Thomas, Steve; Guest, Phillip; Forbes, Karen

doi:10.1016/j.jpainsymman.2008.05.002

Cited by 14 publications

(5 citation statements)

References 8 publications

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“…Different clinical practices of PS in palliative and hospice care in Germany resulting from the presented analysis affect in particular indications for PS, frequency of symptom evaluation during PS, the usage of drugs, and planned weaning phases during PS in this analysis. These deviations are also reflected in and in accordance with the current international research literature which reports a wide range of indications for PS [4, 29], different medications and dosages [5, 6], and patterns of evaluation and monitoring PS [30]. The divergence in clinical practice seems to be associated with different understandings of PS [31–33].…”

Section: Discussionsupporting

confidence: 82%

Palliative sedation in Germany: factors and treatment practices associated with different sedation rate estimates in palliative and hospice care services

et al. 2018

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BackgroundClinical practice of Palliative Sedation (PS) varies between institutions worldwide and sometimes includes problematic practices. Little available research points at different definitions and frameworks which may contribute to uncertainty of healthcare professionals in the application of PS. This analysis investigates what demographic factors and characteristics of treatment practices differ between institutions with high versus low sedation rates estimates in Palliative and Hospice Care in Germany.MethodsData sets from 221 organisations from a prior online survey were separated into two sub-groups divided by their estimated sedation rate A) lower/equal to 16% (n = 187; 90.8%) and B) higher than 16% (n = 19; 9.2%) for secondary analysis. Demographic factors and characteristics of PS treatment practices between the two groups were compared using T-Tests and Chi2/ Fisher Exact Tests and considered significant (*) at two-sided p < .05.ResultsOrganisations in group B report that they discuss PS for a higher proportion of patients (38.5%/10.2%, p < 0.000**), rate agitation more often as an indications for PS (78.9%/ 53.5%, p = 0.050*), and are more likely to use Lorazepam (63.2%/ 37.4%, p = 0.047*), Promethazin (26.3%/ 9.6%, p = 0.044*), and (Es-)Ketamin (31.6%/ 12.8%, p = 0.039*) than representatives in group A. Both groups differ significantly in their allocation of three case scenarios to different types of PS.ConclusionsBoth definitions and patterns of clinical practice between palliative and hospice care representatives show divergence, which may be influenced one by another. A comprehensive framework considering conceptual, clinical, ethical, and legal aspects of different definitions of PS could help to better distinguish between different types and nuances of PS.

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Section: Discussionsupporting

confidence: 82%

Palliative sedation in Germany: factors and treatment practices associated with different sedation rate estimates in palliative and hospice care services

et al. 2018

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“…Palliative sedation should be used rarely. 25 Prevalence of the use of palliative sedation in terminally ill patients has been reported between 1% and 52%. 14,20,22,23 NHPCO supports the use of palliative sedation only in cases where alternative interventions have been exhausted or are otherwise inadvisable (e.g., when the patient is expected to die before an alternative intervention is expected to become effective).…”

Section: Frequency Of Usementioning

confidence: 99%

National Hospice and Palliative Care Organization (NHPCO) Position Statement and Commentary on the Use of Palliative Sedation in Imminently Dying Terminally Ill Patients

Kirk

Mahon

2010

Journal of Pain and Symptom Management

188

149

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“…Antidopaminergic and antihistamines, sedative drugs that also have antiemetic effect, are often used 26 . There is report of a number of cases using ketamine in combination with opioids and benzodiazepines for sedation in terminally ill patients 31,32 and a case report of its use as monotherapy for palliative sedation 33 .…”

Section: Othermentioning

confidence: 99%