Use of sedation to relieve refractory symptoms in dying patients

Abstract

Objectives: To document the use of sedation for refractory symptoms in patients admitted to an independent palliative care unit.

Method: A prospective descriptive study.

Setting: The 7-bed inpatient unit at Sungardens Hospice, Pretoria.

Subjects: Patients who required sedation for refractory symptoms in addition to normal palliative care treatment between January and June 2002.

Findings: Twenty of 100 consecutive patients admitted required sedation. All had advanced cancer. Their mean age was 68 years. Thirty-six per cent were men and 64% women.

Indications: Agitated delirium was the most common reason (45%) for using sedation, followed by intractable vomiting due to inoperable malignant intestinal obstruction in 25% of patients. Three patients with persistent convulsions or myoclonic jerking and 2 patients with severe refractory dyspnoea required some sedation. Intractable pain was the main reason for sedation in only 1 patient.

Survival: Mean survival following the start of sedation was 92 hours/3.8 days (range 6 - 369 hours/0.25 - 19.4 days). The combined mean survival recorded in 9 other studies was 57 hours/2.4 days (range 36 - 93.6 hours/1.5 - 3.9 days).

Medication: The main drugs used for sedation were midazolam and haloperidol. The mean dosage for midazolam was 18.5 mg/24 hours (range 7.5 - 40 mg) and for haloperidol 8 mg/24 hours (range 5 - 10 mg). For pain relief the mean daily dose of parenteral morphine was 76 mg (range 15 - 260 mg).

Conclusion: Use of sedation for the relief of refractory symptoms at Sungardens Hospice is in line with several studies reported in the international literature.