Use of sedation to relieve refractory symptoms in dying patients

To document the use of sedation for refractory symptoms in patients admitted to an independent palliative care unit.

A prospective descriptive study.

The 7-bed inpatient unit at Sungardens Hospice, Pretoria.

Patients who required sedation for refractory symptoms in addition to normal palliative care treatment between January and June 2002.

Twenty of 100 consecutive patients admitted required sedation. All had advanced cancer. Their mean age was 68 years. Thirty-six per cent were men and 64% women.

Agitated delirium was the most common reason (45%) for using sedation, followed by intractable vomiting due to inoperable malignant intestinal obstruction in 25% of patients. Three patients with persistent convulsions or myoclonic jerking and 2 patients with severe refractory dyspnoea required some sedation. Intractable pain was the main reason for sedation in only 1 patient.

Mean survival following the start of sedation was 92 hours/3.8 days (range 6 - 369 hours/0.25 - 19.4 days). The combined mean survival recorded in 9 other studies was 57 hours/2.4 days (range 36 - 93.6 hours/1.5 - 3.9 days).

The main drugs used for sedation were midazolam and haloperidol. The mean dosage for midazolam was 18.5 mg/24 hours (range 7.5 - 40 mg) and for haloperidol 8 mg/24 hours (range 5 - 10 mg). For pain relief the mean daily dose of parenteral morphine was 76 mg (range 15 - 260 mg).

Use of sedation for the relief of refractory symptoms at Sungardens Hospice is in line with several studies reported in the international literature.