Sprij Bram
Huisartsen Centrum Maassluis, The Netherlands. b.sprij@hcmaassluis
Ned Tijdschr Geneeskd. 2010;154:A1983.
The Dutch 'euthanasia and assisted suicide' practice guideline advises using 2000 mg thiopental to induce coma, followed by a muscle relaxant to cause death by respiratory paralysis. However, when a doctor administers such a high dose of thiopental as a bolus injection to a cachectic patient, there is a high likelihood of immediate death and other side effects, which can be distressing for the family. Doctors who administered less than 2000 mg have been reprimanded for not working according to current standards. Arguments are given concerning in which circumstances it is reasonable to use the advised dose of 2000 mg of thiopental and when to use less thiopental to induce coma by direct intravenous injection. The author suggests that it may be better to adjust the dose of thiopental according to the body weight of the patient. The current practice guideline needs revision.
荷兰的“安乐死与协助自杀”实践指南建议使用2000毫克硫喷妥钠诱导昏迷,随后使用肌肉松弛剂,通过呼吸麻痹导致死亡。然而,当医生将如此高剂量的硫喷妥钠作为大剂量注射给恶病质患者时,极有可能立即死亡并产生其他副作用,这可能会让家属感到痛苦。使用剂量低于2000毫克的医生因未按照现行标准操作而受到谴责。文中讨论了在哪些情况下使用建议的2000毫克硫喷妥钠剂量是合理的,以及何时通过直接静脉注射使用较少剂量的硫喷妥钠来诱导昏迷。作者建议,根据患者体重调整硫喷妥钠剂量可能会更好。现行的实践指南需要修订。