Terminal restlessness--its management and the role of midazolam

Abstract

Objective: To describe the clinical picture of the syndrome of terminal restlessness in dying patients and the role and mode of administration of midazolam.

Setting: Hospice unit of a public hospital.

Design: Retrospective review of patient records and search of the literature for reports of the use of midazolam in palliative care from 1988 to 1990 and of the effects and side effects of drugs commonly used in the management of terminal restlessness.

Patients and intervention: Eighty-six patients with terminal restlessness received midazolam to alleviate their symptoms.

Main outcome measures: Improved relaxation in the patients, a reduction in family anxiety and reduced staff stress.

Results: Of the 86 patients with terminal restlessness, all but one obtained benefit. No apparent side effects or adverse reactions to the drug were observed.

Conclusion: Midazolam given by the subcutaneous route can usually provide effective palliation of terminal restlessness when other measures are ineffective. The drug is also useful for providing short-term sedation for uncomfortable procedures and for managing catastrophic terminal events.