Terminal sedation in palliative medicine – definition and review of the literature

Abstract

This paper reviews the reported use of nonopioid medications for terminal sedation. To provide a summary of the available literature, an electronic database search was performed. Thirteen series and 1 4 case reports were identified. Various symptoms, including agitation, pain, and confusion, required terminal sedation. Eleven drugs were used in 342 patients. Most patients were also treated with concurrent opioids and received terminal sedation in an inpatient hospice unit. Midazolam was the most common sedative employed. A good response--defined as adequate sedation--ranged between 75% and 100%. The median time to death following the introduction of terminal sedation was greater than 1 day. No agent appears to have superior efficacy or limiting toxicity.

How Do Cancer Patients Receiving Palliative Care at Home Die? A Descriptive Study

“…Days since the last medical visit; Days since the last nurse visit; Admission to hospital where the patient then died; Drugs administered on an emergency basis to resuscitate (steroids, fluids, inotropics, etc. ), and the doses of these drugs; Who was present at time of death; Death in the presence of the general practitioner (GP); Death in the presence of the palliative home care physician; Death in the presence of other physicians; Death in the presence of the palliative home care nurse; Use of palliative sedation, defined as the use of sedative medication to relieve intolerable suffering in the last days of life; 12 Predefined issues in the last two hours were posed to the caregivers, including death rattle, dyspnea, agitation, tremor, convulsions, pain behavior, peaceful death (multiple choice, if any). Peaceful death was defined as a death free from avoidable distress and suffering for patients, families, and their caregivers, 8 occurring without the previous signs, which were considered sources of suffering.…”

Palliative Sedation in Advanced Cancer Patients Followed at Home: A Retrospective Analysis

“…According to recent definitions, PS is the use of a nonopioid sedative medication to relieve intolerable suffering in the last days of life. 4,5 PS is considered to be an effective treatment modality for refractory symptoms when aggressive efforts fail to provide relief in terminally ill patients with cancer. 6 Although in one study the frequency of PS at home was higher than that reported in hospital (36% vs. 21%), only 36% of patients who were followed by the palliative care team died at home.…”

Palliative Sedierung auf einer universitären Palliativstation

“…Es wird empfohlen, sie nicht mit dem Ziel der Sedierung, sondern ausschließlich zur Analgesie einzusetzen [3]. Die Dosierungen, die für eine sedierende Wirkung nötig wären, weisen ein zu hohes Nebenwirkungsprofil auf und kön-nen die Symptomlast am Ende des Lebens verstärken, statt sie zu lindern [22]. Um eine gute Kontrolle von Symptomen wie beispielsweise Schmerz oder Dyspnoe erreichen zu können, sollten Opioide (wie in der vorliegenden Studie) nur dann weiter verabreicht werden, wenn sie schon vorher zur Symptomkontrolle eingesetzt wurden.…”