Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0600097 (Sedation)
 1,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We reviewed the circumstances surrounding the use of sedation for symptom control in a Japanese hospice. Of 143 inpatients, 69 (48.3%) received sedation and died an average 3.9 days after sedation was begun. Symptoms requiring sedation included dyspnea, pain, general malaise, agitation, and nausea. In 83% of cases, those symptoms were escalating as death approached. In about one-half of the cases, sedation was carried out intermittently until the patient died. Sedation was gained by such sedatives as midazolam, morphine, and haloperidol. Side effects included suppression of the respiratory and/or circulatory system in nine cases (in four cases it caused death), and delirium in one case; tolerance and dependence were also observed in two cases. We also examined the explanation to and understanding of the patients and their family members about sedation. This experience suggested the type of communication methods that are likely to be useful in Japan. It stresses the importance of intermittent use of sedation and communication with family members. We propose criteria for sedation to improve symptom control that would be acceptable in Japan.
 ...
PMID:Sedation for symptom control in Japan: the importance of intermittent use and communication with family members. 871 14

We report an open, uncontrolled study to evaluate the effectiveness of regular oral morphine as symptomatic treatment of dyspnoea in patients with advanced cancer receiving standard clinical care. Fifteen patients were assessed initially, and then 48 h and 7-10 days after starting treatment with oral morphine or having their dose increased. Dyspnoea, measured on a visual analogue scale (0-100), fell by a median of 14 (95% confidence interval -1.5, 25.5; Wilcoxon statistic 32.0; P = 0.06) in the nine who completed all three assessments. The three patients who died during the study did not show symptomatic benefit and, like the three who withdrew, experienced increased sedation and/or dizziness. Sedation was significantly increased at 48 h; median rise 10.5 (95% confidence interval 7, 25; Wilcoxon statistic 74; P = 0.007). Baseline respiratory function (FEV1, FVC, peak flow) was poor and the patients' respiratory rate was unaffected. Regular, titrated oral morphine may improve dyspnoea in some patients with advanced cancer but can cause significant short-term adverse effects. Oral morphine should be given to these patients as a therapeutic trial. Patients should be advised about side-effects and carefully monitored. Larger studies are needed to establish which patients are most likely to benefit and optimal dosage regimens.
 ...
PMID:Oral morphine as symptomatic treatment of dyspnoea in patients with advanced cancer. 937 78

Sedation is a clinically important therapeutic intervention in the imminently dying patient. As the patient with an advanced, irreversible illness nears the end of life, symptoms accumulate that are progressively more difficult to manage and that may become refractory to standard medical interventions. The most common of these intractable symptoms are pain, agitated delirium, dyspnea, and existential or psychological distress. Various therapeutic options available for relieving these symptoms include physician-assisted suicide, euthanasia, acceptance of unrelieved suffering, and terminal sedation. Some commentators have voiced concerns that sedating the imminently dying patient inevitably hastens death, and that this practice, in fact, is a surrogate form of physician-assisted suicide or euthanasia. Ethical arguments invoked to support the use of terminal sedation include the principle of double effect, which draws a moral distinction between the intention of an act (in this case, to relieve suffering) and its foreseen but unintended consequence (premature death). This author views sedation as a necessary, although risk-laden, procedure that, if practiced by trained, dedicated clinicians, maintains the physician's twin obligations to benefit patients and to "do no harm."
 ...
PMID:Sedation in the imminently dying patient. 1082 17

This study assessed sedation in terminal cancer patients in terms of three characteristics: frequency; relationship to intractable symptoms; and the extent to which medical staff, family, and patients found sedation to be ethically acceptable and efficacious. Two hundred seventy-six consecutive patients, who were admitted to the palliative care unit of National Taiwan University Hospital in Taiwan between August 1998 and the end of May 1999, were enrolled. A recording form was completed every day. This included demographic data, pain and common symptom scores, and the use of sedation in the terminal phase. Seventy (27.9%) of 251 patients who died received sedation. Sedation was administered to relieve agitated delirium in 40 (57.1%), dyspnea in 16 (22.8%), severe pain in 7 (10%) and insomnia in 5 (7.2%). The drugs used for sedation were haloperidol in 35 (50%), midazolam in 17 (24.3%), and rapidly increasing dosage of morphine in 9 (12.9%). In fewer than half (42.9%) of the patients, sedation was with the consent of both patient and family, and half (50%) had the consent of family alone. The overwhelming majority of medical staff and family felt the decision to use terminal sedation was ethically acceptable. There was no significant difference in survival time between sedated and non-sedated patients (28.49 vs. 24.71 days, t = -0.791, P = 0.430). Positive ethical acceptability and higher satisfaction with symptom control with terminal sedation were found in both medical staff and family in this study. Further work is needed to find the most appropriate time of intervention and to improve management of refractory symptoms in dying patients.
 ...
PMID:Sedation for refractory symptoms of terminal cancer patients in Taiwan. 1139 4

BACKGROUND: The administration of sedatives in terminally ill patients becomes an increasingly feasible medical option in end-of-life care. However, sedation for intractable distress has raised considerable medical and ethical concerns. In our study we provide a critical analysis of seven years experience with the application of sedation in the final phase of life in our palliative care unit. METHODS: Medical records of 548 patients, who died in the Palliative Care Unit of GK Havelhoehe between 1995-2002, were retrospectively analysed with regard to sedation in the last 48 hrs of life. The parameters of investigation included indication, choice and kind of sedation, prevalence of intolerable symptoms, patients' requests for sedation, state of consciousness and communication abilities during sedation. Critical evaluation included a comparison of the period between 1995-1999 and 2000-2002. RESULTS: 14.6% (n = 80) of the patients in palliative care had sedation given by the intravenous route in the last 48 hrs of their life according to internal guidelines. The annual frequency to apply sedation increased continuously from 7% in 1995 to 19% in 2002. Main indications shifted from refractory control of physical symptoms (dyspnoea, gastrointestinal, pain, bleeding and agitated delirium) to more psychological distress (panic-stricken fear, severe depression, refractory insomnia and other forms of affective decompensation). Patients' and relatives' requests for sedation in the final phase were significantly more frequent during the period 2000-2002. CONCLUSION: Sedation in the terminal or final phase of life plays an increasing role in the management of intractable physical and psychological distress. Ethical concerns are raised by patients' requests and needs on the one hand, and the physicians' self-understanding on the other hand. Hence, ethically acceptable criteria and guidelines for the decision making are needed with special regard to the nature of refractory and intolerable symptoms, patients' informed consent and personal needs, the goals and aims of medical sedation in end-of-life care.
 ...
PMID:Sedation in palliative care - a critical analysis of 7 years experience. 1274 22

Palliative sedation is the intentional lowering of the level of consciousness ofa patient in the last phase of life by means of the administration of sedatives. The objective of palliative sedation is to relieve severe physical or psychological suffering that is otherwise untreatable. Sedation is used in 12% of all patients dying in the Netherlands. Refractory delirium, dyspnoea or pain are the most common indications. If deep palliative sedation is used, the estimated life expectancy should be a few days to at most one week. Midazolam is used most often for continuous sedation, usually by subcutaneous infusion; if the response is insufficient, a combination of midazolam with levomepromazine or phenobarbital or monotreatment with propofol may be used. If continuous infusion is not desired or feasible, intermittent administration of midazolam, diazepam, lorazepam or chlorpromazine may be considered. Provided that it is used under the right circumstances, palliative sedation does not shorten life.
 ...
PMID:[Palliative sedation]. 1596 Jan 40

Although palliative sedation therapy is often required in terminally ill cancer patients to achieve acceptable symptom relief, empirical data supporting the ethical validity of this approach are lacking. The primary aim of this study was to systematically investigate whether empirical evidence supports the ethical validity of sedation. This was a multicenter, prospective, observational study, which was conducted by 21 specialized palliative care units in Japan. One-hundred two consecutive adult cancer patients who received continuous deep sedation were enrolled. Continuous deep sedation was defined as the continuous use of sedative medications to relieve intolerable and refractory distress by achieving almost or complete unconsciousness until death. Prior to the study, we conceptualized the ethical validity of sedation from the viewpoints of physicians' intent, proportionality, and autonomy. Sedation was performed mainly with midazolam and phenobarbital. The initial doses of midazolam and phenobarbital were 1.5 mg/hour and 20 mg/hour, respectively. Main administration routes were continuous subcutaneous infusion and continuous intravenous infusion, and no rapid intravenous injection was reported. Of 59 patients who received artificial hydration or could intake adequate fluids/foods orally before sedation, 63% received artificial hydration therapy after sedation, and in the remaining patients, artificial hydration was withheld or withdrawn due to fluid retention symptoms and/or patient wishes. Of 66 patients who were able to verbally express themselves, 95% explicitly stated that symptoms were intolerable. The etiologies of the symptoms requiring sedation were primarily related to the progression of the underlying malignancy, such as cancer cachexia and organ failure, and standard palliative treatments had failed: steroids in 68% of patients with fatigue, opioids in 95% of patients with dyspnea, antisecretion medications in 75% of patients with bronchial secretion, antipsychotic medications in 74% of patients with delirium, and opioids in all patients with pain. On the basis of the Palliative Prognostic Index, 94% of the patients were predicted to die within 3 weeks. Before sedation, 67% of the patients expressed explicit wishes for sedation. In the remaining 34 patients, previous wishes for sedation were noted in 4 patients, and in the other 30 patients, the families were involved in the decision-making process. The chief reason for patient non-involvement in the decision making was cognitive impairment. These data indicate that palliative sedation therapy performed in specialized palliative care units in Japan generally followed the principles of double effect, proportionality, and autonomy.
 ...
PMID:Ethical validity of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. 1625 95

Thee different combinations of ketamine hydrochloride were used to induce general anaesthesia for surgical operations (typhlectomy) in 30 adult, single-comb White Leghorn cockerels. They were randomly divided into three groups, each comprising 10 birds. Birds in Group I received xylazine-ketamine combinations at the dose rate of 2 mg xylazine and 10 mg ketamine per kg i.v., whereas birds of Group II received diazepam (2.5 mg/kg i.v.) and 5 min later ketamine (75 mg/kg i.m.). In the Group III, midazolam (2 mg/kg i.m.) and 5 min later ketamine (50 mg/kg i.v.) was administered. The onset of sedation/anaesthesia was shortest (1.60 +/- 0.27 min) in Group I, followed by Group II (8.40 +/- 0.83 min) and Group III (17.10 +/- 1.71 min). Recovery period was shortest in the Group I (65-75 min) followed by Group II (80-85 min) and Group III (92-105 min). Sedation, muscle relaxation and surgical anaesthesia was optimal and excellent in Group I compared with the other two groups. Torticollis, salivation and dyspnoea were observed in Group III. Short-term limb contractions were present in all birds in Groups II and III, up to 20 min of observation. Recovery from anaesthesia was smooth in all three groups. A Surgical procedure (typhlectomy) was performed on all birds. Hypothermia was observed in Group II, whereas heart and respiratory depression was recorded in Group I. Blood sugar level did not vary significantly in any anaesthetic regime. The reduction of haemoglobin was maximum in Group II compared with Groups I and III. Hypoxaemia and hypercapnaea were elevated in all birds in Groups II and III. Blood electrolytes did not vary significantly from the baseline values among the three groups of birds during the period of observation (120 min). The xylazineketamine combination was found to be the best anaesthesia for surgical intervention in chickens.
 ...
PMID:Xylazine, diazepam and midazolam premedicated ketamine anaesthesia in white Leghorn cockerels for typhlectomy. 1670 Apr 70

Of 1200 palliative care patients, 28 received palliative sedation. They were more likely than patients without palliative sedation to have an Eastern Cooperative Oncology Group performance status of at least 3, a cancer diagnosis, an expected survival of weeks or less, to have been monitored by the palliative care team for at least 1 week, to have delirium as the cause of decreased communication, to have dyspnea as a non-pain symptom, and to be less able to communicate symptoms. Almost 90% received palliative sedation for at least 24 hours for a median of 3 days (range, 0 to 24 days). Home patients received palliative sedation longer. Symptoms were controlled in 82% and improved in the rest. Sedation developed in 79% but was not required for symptom control in 5. Patient survival from palliative care consultation was a median of 8 days (range, 0 to 32 days).
 ...
PMID:Palliative sedation in a southern Appalachian community. 1706 Mar 3

Sedation of critically ill patients undergoing mechanical ventilation should be minimized or completely avoided. Only in selected situations is sedation indicated as first line therapy (increased intracranial pressure or therapeutic hypothermia). The critical care physicians primary objective should be to focus on the reversible causes of agitation, such as: pain, anxiety, delirium, dyspnea, withdrawal symptoms, sleep or gastrointestinal symptoms. If sedation is used a validated sedation scale is recommended. On a daily basis sedation should be interrupted and only restarted after a thorough search for reversible causes of discomfort and stress.
 ...
PMID:Danish national sedation strategy. Targeted therapy of discomfort associated with critical illness. Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM). 2587 38


1 2 Next >>