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Related Concept Videos

Stages of General Anesthesia01:22

Stages of General Anesthesia

Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
General Anesthesia: Overview01:24

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
Sedatives and Hypnotics: Overview01:23

Sedatives and Hypnotics: Overview

Sedatives are drugs that alleviate anxiety, while hypnotics induce sleep. Both classes of medication suppress neuronal activity, leading to a calming effect for sedatives and facilitating sleep for hypnotics.
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
Sedatives and Hypnotics Drugs: Miscellaneous Agents01:17

Sedatives and Hypnotics Drugs: Miscellaneous Agents

Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
Sedatives and Hypnotics Drugs: Barbiturates01:20

Sedatives and Hypnotics Drugs: Barbiturates

Sedatives and hypnotics encompass a drug class that acts on the central nervous system (CNS) to alleviate anxiety, promote relaxation and induce sleep.These drugs function by amplifying the actions of the neurotransmitter γ-aminobutyric acid (GABA), resulting in reduced neuronal activity. Barbiturates, a subset of sedatives and hypnotics first synthesized in the late 1800s, are categorized into ultra-short, short, intermediate, and long-acting groups based on their duration of effect. A key...

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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
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Consent in terminal sedation.

Lalit Krishna1

  • 1Department of Palliative Medicine, National Cancer Center Singapore, 11 Hospital Drive, Singapore 169610. lalit.krishna@nccs.com.sg

Indian Journal of Medical Ethics
|September 2, 2010
PubMed
Summary
This summary is machine-generated.

For patients with intractable end-of-life symptoms, terminal sedation may be considered when palliative care fails. This paper argues that seeking informed consent is not feasible, advocating for the Best Interest Principle to guide treatment decisions.

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Area of Science:

  • Medical Ethics
  • Palliative Care
  • End-of-Life Care

Background:

  • Many end-of-life patients experience intractable symptoms despite comprehensive palliative care.
  • Terminal sedation is a controversial intervention for refractory symptoms.
  • The issue of informed consent in terminal sedation is a significant ethical challenge.

Purpose of the Study:

  • To examine the ethical considerations of informed consent for terminal sedation.
  • To propose an alternative ethical framework for decision-making in intractable end-of-life symptom management.
  • To advocate for the application of the Best Interest Principle in specific clinical scenarios.

Main Methods:

  • Analysis of a clinical scenario involving intractable end-of-life symptoms.
  • Ethical discussion on the feasibility and meaningfulness of informed consent under duress.
  • Argumentation for the Best Interest Principle as a guiding ethical standard.

Main Results:

  • Informed consent may be neither useful nor meaningful for patients experiencing extreme physical and psychological distress.
  • The Best Interest Principle offers a viable ethical pathway for physicians.
  • Physicians should prioritize alleviating suffering when informed consent is impractical.

Conclusions:

  • Terminal sedation decisions for patients with intractable symptoms require careful ethical consideration.
  • The Best Interest Principle can guide physicians in acting for the patient's well-being when consent is impossible.
  • Prioritizing patient comfort and suffering alleviation is paramount in end-of-life care.