title: [Palliative sedation in a man with oral cancer; the Royal Dutch Medical Association guidelines not always sufficient].
abstract: BACKGROUND
  Palliative sedation is an effective treatment option in patients with refractory symptoms in the last phase of life. In 2009 the Royal Dutch Medical Association (KNMG) published revised guidelines. The dosage of propofol recommended in these guidelines is, however, based on one single study.
  
  
  METHODS
  A 60-year-old patient with a history of psychiatric disease and alcohol abuse was admitted to the palliative care unit suffering from unbearable pain from a squamous carcinoma of the floor of the oral cavity. Adequate treatment of his symptoms was initially possible, but when his symptoms became refractory we initiated continual sedation. Adequate symptom control was only achieved when propofol was administered in a high dosage of 150 mg/h and levomepromazine administration was reinitiated.
  
  
  CONCLUSIONS
  In our opinion the advised starting dose of propofol is too low, especially in comparison with sedation in regional anaesthesia described in the literature. Furthermore, we advocate that administration of drugs from step 2, midazolam and levomepromazine, is not discontinued when propofol sedation is commenced in step 3.
authors.affiliation: Isala klinieken, Afd. Anesthesiologie, Zwolle, the Netherlands. w.l.h.smelt@isala.nl
authors.forename: W L H Erwin
authors.initials: WL
authors.lastname: Smelt
authors.forename: Els T J
authors.initials: ET
authors.lastname: Wulffraat
authors.forename: Frans J G
authors.initials: FJ
authors.lastname: Broekhoff
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Dompeling
authors.forename: J Hanneke
authors.initials: JH
authors.lastname: Vos-Westerman
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000188:drug therapy; D016292:Procedural Sedation / Q000592:standards; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000150:complications* / Q000188:drug therapy; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010166:Palliative Care / Q000379:methods / Q000592:standards; D015742:Propofol / Q000592:standards / Q000627:therapeutic use
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol