[A case of dexmedetomidine administration for slight end-stage sedation in a patient with sudden continuous bleeding]

We report a case of sudden fatal bleeding during the treatment of pancreatic cancer. The patient underwent palliative treatment for his symptoms with hydroxyethyl starch (HES) and continuous dexmedetomidine. He suffered from advanced pancreatic cancer, underwent gastrojejunostomy, and was scheduled to undergo chemotherapy. He suddenly vomited large amounts of blood and his blood pressure fell. Computed tomography revealed a hole in the branch of the arteria mesenterica superior that supplies the duodenum; best supportive care was selected. The patient suffered from pain associated with low blood pressure throughout his body. Infusion of 6% HES and continuous dopamine alleviated the pain and normalized his blood pressure. Continuous dexmedetomidine reduced his fatigue. He was able to talk comfortably with his family for 72 hours during treatment. Subsequently, his level of consciousness deteriorated and we administered haloperidol and midazolam for continuous sedation. He died painlessly 120 hours later after dexmedetomidine initiation.