title: The anesthesiologist and end-of-life care.
abstract: OBJECTIVE
  Anesthesiologists may face problematic situations when patients are close to death, in which clinical problems, decision-making processes, and ethical issues are often interconnected and dependent on each of them. The aim of this review is to assess the recent literature regarding the anesthesiological role for advanced cancer patients.
  
  
  RESULTS
  Palliative sedation in the dying patients, end-of-life problems in the ICU, and pain control in advanced cancer patients have been the subject of recent research. All these issues have shown that anesthesiologist would be expert in the field of pain and symptom control at the end of life. End-of-life care problems are common in ICU, and a decision-making process requires knowledge and management of patients' wishes, past and projected future quality of life, severity and prognosis of illness, patients' age, regarding withholding and withdrawing of futile treatments in anticipation of death, or relieving symptoms close to death.
  
  
  CONCLUSIONS
  Anesthesiologists should be competent in all aspects of terminal care, including the practical and ethical aspects of withdrawing different modalities of life-sustaining treatment and the use of sedatives, analgesics, and nonpharmacologic approaches to easing the suffering of the dying process. More research is needed to provide models which should be spread in the scientific community to afford this difficult task.
authors.affiliation: Anesthesia & Intensive Care and Pain Relief & Supportive Care Unit, La Maddalena Cancer Center, University of Palermo, Italy. terapiadeldlore@lamaddalenanet.it
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Mercadante
authors.forename: Antonello
authors.initials: A
authors.lastname: Giarratano
mesh_terms: D000758:Anesthesia / Q000379:methods*; D000776:Anesthesiology / Q000379:methods*; D016292:Procedural Sedation; D003422:Critical Care; D006801:Humans; D009369:Neoplasms / Q000150:complications; D059408:Pain Management; D010166:Palliative Care; D013727:Terminal Care