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Deep terminal sedation

Peter Pype, Inge Teuwen, Fien Mertens, Marij Sercu, An De Sutter
OBJECTIVES: Palliative sedation is a therapeutic option to control refractory symptoms in terminal palliative patients. This study aims at describing the occurrence and characteristics of suboptimal palliative sedations in primary care and at exploring the way general practitioners (GPs) experience suboptimal palliative sedation in their practice. METHODS: We conducted a mixed methods study with a quantitative prospective survey in primary care and qualitative semi-structured interviews with GPs...
June 5, 2017: Acta Clinica Belgica
H Sauer, J Pfeifer, S Gräber, H Abdul-Khaliq
Introduction Most pediatric patients require deep sedation for a TEE examination. We analyzed the data of our sedation protocols relating to all outpatient TEEs in patients under 18 years of age for the year 2011. On the basis of the data records of a total of 40 patients, we will describe our standard and compare it with the findings of the international literature. Material and Methods In a retrospective analysis, we inspected our sedation protocols in terms of patient-related data, vital parameters, drug applications, occurring complications and necessary interventions as well as nausea and vomiting during the post-sedative monitoring phase...
January 2017: Klinische Pädiatrie
R Aubry
On February 2, 2016, the French parliament adopted legislation creating new rights for the terminally ill. The text modifies and reinforces the rights of patients to end-of-life care and strengthens the status of surrogate decision makers. Under the new regulations, advance directives become legally binding though not unenforceable. Two types of advance directives are distinguished depending on whether the person is suffering or not from a serious illness when drafting them. The attending physician must abide by the patient's advance directives except in three situations: there is a life-threatening emergency; the directives are manifestly inappropriate; the directives are not compatible with the patient's medical condition...
December 2016: Revue Neurologique
Abigail C Mancuso, Kelsey Lee, Ran Zhang, Elizabeth A Hoover, Colleen Stockdale, Abbey J Hardy-Fairbanks
OBJECTIVES: Safety of outpatient dilation and evacuations with intravenous (iv) sedation without intubation has been demonstrated, but there is a paucity of data on deep iv sedation on an inpatient second trimester surgical termination population. The purpose of this study is to evaluate complications of deep sedation with propofol without the use of intubation during second trimester surgical terminations in an inpatient teaching institution. STUDY DESIGN: A retrospective chart review of all obstetrical and anesthetic data from inpatient dilation and evacuations between gestational ages 15 0/7 and 24 0/7 during the years 2002 to 2015...
March 2017: Contraception
Jean François Ciais, Flora Tremellat, Maud Castelli-Prieto, Caroline Jestin
BACKGROUND: At the end of life, patients may feel refractory pain during care procedures although they receive appropriate analgesia. They can benefit from a short-term sedation. Propofol is used for procedural sedation in emergency or reanimation departments. It may be adapted in a palliative care unit. OBJECTIVE: The main objective was to verify whether propofol could allow us to administer care without causing major pain to patients with refractory pain at the end of life...
March 2017: Journal of Palliative Medicine
Kasper Raus, Kenneth Chambaere, Sigrid Sterckx
BACKGROUND: Continuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying. The practice is generally considered to be legal as a form of symptom control, although this is mostly only assumed. France has passed an amendment to the Public Health Act that would grant certain terminally ill patients an explicit right to continuous deep sedation until they pass away...
June 29, 2016: BMC Medical Ethics
Robert Zittoun
Continuous sedation until death (CSUD) is a practice which has developed recently in several countries, appearing more acceptable than euthanasia and medically assisted suicide, since more close to a "natural death". The French parliament has just adopted a law which stipulates CSUD on request of the patient in a definite number of circumstances, especially in incurable diseases near to the terminal stage with suffering refractory to treatments. Thus France has adopted a unique international position for the end-of-life care...
July 2016: La Presse Médicale
Jean-Yves Nau
No abstract text is available yet for this article.
March 18, 2015: Revue Médicale Suisse
George P Smith
Since the beginning of the hospice movement in 1967, "total pain management" has been the declared goal of hospice care. Palliating the whole person's physical, psychosocial, and spiritual states or conditions is central to managing the pain that induces suffering. At the end-stage of life, an inextricable component of the ethics of adjusted care requires recognition of a fundamental right to avoid cruel and unusual suffering from terminal illness. This Article urges wider consideration and use of terminal sedation, or sedation until death, as an efficacious palliative treatment and as a reasonable medical procedure in order to safeguard the "right" to a dignified death...
2011: Cornell Journal of Law and Public Policy
Kaspar Raus, Martine de Laat, Eric Mortier, Sigrid Sterckx
Continuous sedation at the end of life is a practice that has attracted a great deal of attention. An increasing number of guidelines on the proposed correct performance of the practice have been drafted. All of the guidelines stress the importance of using sedation in proportion to the severity of the patient's symptoms, thus to reduce the patient's consciousness no more than is absolutely necessary. As different patients can have different experiences of suffering, the amount of suffering should, ideally, be assessed subjectively; that is, via communication with the patient...
2014: Journal of Clinical Ethics
Peter G Lawlor, Shirley H Bush
Delirium is a frequent neurocognitive complication in patients with cancer, particularly in patients with advanced-stage disease (in whom a combination of factors might trigger an episode) and in patients with a high degree of predisposing vulnerability, such as the elderly or patients with dementia. The communicative impediments associated with delirium generate distress for the patient and their family, and substantive challenges for health-care practitioners, who might have to contend with agitation, and difficulty in assessing pain and other symptoms...
February 2015: Nature Reviews. Clinical Oncology
Jane Seymour, Judith Rietjens, Sophie Bruinsma, Luc Deliens, Sigrid Sterckx, Freddy Mortier, Jayne Brown, Nigel Mathers, Agnes van der Heide
BACKGROUND: Extensive debate surrounds the practice of continuous sedation until death to control refractory symptoms in terminal cancer care. We examined reported practice of United Kingdom, Belgian and Dutch physicians and nurses. METHODS: Qualitative case studies using interviews. SETTING: Hospitals, the domestic home and hospices or palliative care units. PARTICIPANTS: In all, 57 Physicians and 73 nurses involved in the care of 84 cancer patients...
January 2015: Palliative Medicine
Marco Maltoni, Emanuela Scarpi, Oriana Nanni
PURPOSE OF REVIEW: The purpose of this review is to provide an update on palliative sedation in palliative and end-of-life care. Palliative sedation is the medical procedure used to deal with refractory symptoms in advanced cancer patients when all other specific approaches have failed. RECENT FINDINGS: Palliative sedation, in the strictest sense of the term, is a proportionate (proportionate palliative sedation, PPS) and intrinsically variable procedure used on an individual basis to relieve refractory symptoms in terminally ill patients, without the intention of hastening death...
July 2014: Current Opinion in Oncology
Lars Johan Materstvedt
Palliative sedation at the end of life has become an important last-resort treatment strategy for managing refractory symptoms as well as a topic of controversy within palliative care. Furthermore, palliative sedation is prominent in the public debate about the possible legalisation of voluntary assisted dying (physician-assisted suicide and euthanasia). This article attempts to demonstrate that palliative sedation is fundamentally different from euthanasia when it comes to intention, procedure, outcome and the status of the person...
March 2012: BMJ Supportive & Palliative Care
Evangelia Evie Papavasiliou, Sheila Payne, Sarah Brearley
PURPOSE: End-of-life sedation, though increasingly prevalent and widespread internationally, remains one of the most highly debated medical practices in the context of palliative medicine. This qualitative study aims to elicit and record the perspectives of leading international palliative care experts on current debates. METHODS: Twenty-one professionals from diverse backgrounds, sharing field-specific knowledge/expertise defined by significant scholarly contribution on end-of-life sedation, were recruited...
August 2014: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Gail A Van Norman
PURPOSE OF REVIEW: Physician-assisted suicide (PAS) and euthanasia have been increasingly discussed in end-of-life care, as PAS and euthanasia have now been legalized in three European countries and PAS has been legalized in Washington, Oregon, and Montana in the USA. This review focuses on some aspects of PAS and euthanasia and discusses deep terminal sedation (DTS), which is increasingly used to treat intractable symptoms at the end of life. RECENT FINDINGS: PAS and euthanasia present potential risks for vulnerable populations, such as the depressed and disabled...
April 2014: Current Opinion in Anaesthesiology
Siebe J Swart, Agnes van der Heide, Lia van Zuylen, Roberto S G M Perez, Wouter W A Zuurmond, Paul J van der Maas, Johannes J M van Delden, Judith A C Rietjens
BACKGROUND: Palliative sedation is a medical intervention aimed at relieving symptoms that can no longer be controlled by conventional treatment. Ample knowledge is available regarding the nature of such symptoms, but there is no in-depth information regarding how health care workers decide about palliative sedation. OBJECTIVE: The study objective was to investigate considerations concerning the indications for continuous palliative sedation (CPS) and issues that influence these considerations...
January 2014: Journal of Palliative Medicine
Kazuhiko Koike, Takeshi Terui, Yuji Takahashi, Yasuo Hirayama, Naomi Mizukami, Michiaki Yamakage, Junji Kato, Kunihiko Ishitani
OBJECTIVE: Continuous deep sedation (CDS) is a way to reduce conscious experience of symptoms of severe suffering in terminally ill cancer patients. However, there is wide variation in the frequency of its reported. So we conducted a retrospective analysis to assess the prevalence and features of CDS in our palliative care unit (PCU). METHODS: We performed a systemic retrospective analysis of the medical and nursing records of all 1581 cancer patients who died at the PCU at Higashi Sapporo Hospital between April 2005 and August 2011...
April 2015: Palliative & Supportive Care
Ian Koper, Agnes van der Heide, Rien Janssens, Siebe Swart, Roberto Perez, Judith Rietjens
PURPOSE: Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services...
January 2014: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Livia Anquinet, Judith A C Rietjens, An Vandervoort, Jenny T van der Steen, Robert Vander Stichele, Luc Deliens, Lieve Van den Block
OBJECTIVES: To describe the characteristics of continuous deep sedation until death and the prior decision-making process of nursing home residents dying with dementia and to evaluate this practice according to features reflecting sedation guideline recommendations. DESIGN: Epidemiological retrospective study completed using a case series analysis. SETTING: Flemish nursing homes in 2010. PARTICIPANTS: From a representative sample of 69 nursing homes, all residents who had dementia and had been continuously and deeply sedated until death over a period of 3 months were selected...
October 2013: Journal of the American Geriatrics Society
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