[Treatment of intolerable sufferings in a hospice unit].
BACKGROUND
Sedation of terminally ill patients is a debated issue. The prescription of sedative drugs to dying patients in a Norwegian unit for palliative care has been studied.


METHODS
Journals from 47 patients, who died in Sunniva Hospice in Bergen during 2003, were examined retrospectively. All opioid analgesics and sedatives given to the patients during the last two days of life were recorded, as well as additional supportive treatment. The degree of consciousness was evaluated and classified in three levels.


RESULTS
All patients were given opioids, and 34 were given sedatives in addition. Midazolam was the most frequently prescribed drug. Seven patients received midazolam in doses that were considered as potentially sedative (> 20 mg/day). All seven had advanced cancer and five of them had metastases to lungs, bone or both. The most common reasons to give high doses of sedatives were intolerable pain and dyspnoea, often combined with an increase in tolerance. One patient required acute sedation. Even though reduced consciousness was observed in some patients, none met the criteria for palliative sedation of dying patients.


CONCLUSIONS
Drugs that may reduce consciousness are often prescribed to dying patients. As long as the aim is to reduce specific symptoms, this is a natural part of palliative treatment. Documentation with specification for the aim of the treatment is mandatory. This is especially important when consciousness is reduced.
Rosland
Jan Henrik
JH
Sunniva klinikk for lindrende behandling, Haraldsplass Diakonale Sykehus, Postboks 6165, 5892 Bergen. jhro@haraldsplass.no
Saunes
Therese K
TK
Bull
Asta Nesse
AN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D005260:Female; D006738:Hospices; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D013727:Terminal Care
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009020:Morphine; D008874:Midazolam