title: Long-Term Intermittent Palliative Sedation for Refractory Symptoms at the End of Life in Two Cancer Patients.
abstract: BACKGROUND
  Palliative sedation (PS) can be classified as either continuous or intermittent. Continuous PS is most commonly used in end-of-life care, while no specific indication for intermittent PS exists.
  
  
  METHODS
  Here we describe two cases of refractory severe cancer pain with psychological anguish that were controlled successfully by intermittent IPS for the long time. One patient complained of refractory severe cancer pain and insomnia. The other patient had uncontrollable pain and delirium, whose sufferings were relieved by intermittent PS. Case Management and Outcome: Intermittent PS was offered to the cases every night-time with family member/patient's consent. After providing intermittent PS, cancer pain decreased to mild intensity and psychological symptoms were significant improved simultaneously with patients awake during day time.
  
  
  CONCLUSIONS
  Palliative PS may stop vicious cycle of physical and psychological distress in terminal cancer patients. Furthermore, intermittent type of PS could keep patients consciousness alert during day time and may be performed repeatedly for the long time.
authors.affiliation: 1 Department of Internal Medicine, School of Medicine, Gyeongsang National University , Jinju, Korea.|4 Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea .
authors.forename: Haa-Na
authors.initials: HN
authors.lastname: Song
authors.affiliation: 1 Department of Internal Medicine, School of Medicine, Gyeongsang National University , Jinju, Korea.
authors.forename: Un Seok
authors.initials: US
authors.lastname: Lee
authors.affiliation: 1 Department of Internal Medicine, School of Medicine, Gyeongsang National University , Jinju, Korea.
authors.forename: Gyeong-Won
authors.initials: GW
authors.lastname: Lee
authors.affiliation: 2 Department of Internal Medicine, College of Medicine, Chung-Ang University , Seoul, South Korea .
authors.forename: In Gyu
authors.initials: IG
authors.lastname: Hwang
authors.affiliation: 1 Department of Internal Medicine, School of Medicine, Gyeongsang National University , Jinju, Korea.
authors.forename: Jung Hun
authors.initials: JH
authors.lastname: Kang
authors.affiliation: 3 Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center , Houston, Texas.
authors.forename: Bruera
authors.initials: B
authors.lastname: Eduardo
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D016292:Procedural Sedation / Q000379:methods*; D003693:Delirium / Q000188:drug therapy*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000556:secondary; D012004:Rectal Neoplasms / Q000473:pathology; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed