title: Ketamine-fentanyl-midazolam infusion for the control of symptoms in terminal life care.
abstract: In this report, we describe nine terminally ill patients with metastatic cancer who were treated with an intravenous infusion consisting of ketamine (2 mg/ml)/fentanyl (5 micrograms/ml)/midazolam (0.1 mg/ml) (K/F/M) to control pain after traditional analgesic therapies were unsuccessful. In addition to pain, all patients exhibited some symptoms of cognitive compromise and agitation. After initiation of the K/F/M infusion, all patients exhibited some degree of qualitative improvement in these symptoms as well as in overall pain control. We feel that these observations warrant reporting of the efficacy of this infusion for the treatment of uncontrolled pain and agitation in terminally ill patients when the traditional methods of pain control are inadequate.
authors.affiliation: Department of Anesthesiology, Pain Management Service, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Berger
authors.forename: A
authors.initials: A
authors.lastname: Ryan
authors.forename: N
authors.initials: N
authors.lastname: Vadivelu
authors.forename: P
authors.initials: P
authors.lastname: Merriam
authors.forename: L
authors.initials: L
authors.lastname: Rever
authors.forename: P
authors.initials: P
authors.lastname: Harrison
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000494:pharmacology / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000188:drug therapy* / Q000209:etiology; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007649:Ketamine / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000209:etiology; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D016194:Receptors, N-Methyl-D-Aspartate; D007649:Ketamine; D008874:Midazolam; D005283:Fentanyl