Anesthesia & Intensive Care and Pain Relief & Supportive Care Unit, La Maddalena Cancer Center, University of Palermo, Italy.
Curr Opin Anaesthesiol. 2012 Jun;25(3):371-5. doi: 10.1097/ACO.0b013e3283530e7d.
Anesthesiologists may face problematic situations when patients are close to death, in which clinical problems, decision-making processes, and ethical issues are often interconnected and dependent on each of them. The aim of this review is to assess the recent literature regarding the anesthesiological role for advanced cancer patients.
Palliative sedation in the dying patients, end-of-life problems in the ICU, and pain control in advanced cancer patients have been the subject of recent research. All these issues have shown that anesthesiologist would be expert in the field of pain and symptom control at the end of life. End-of-life care problems are common in ICU, and a decision-making process requires knowledge and management of patients' wishes, past and projected future quality of life, severity and prognosis of illness, patients' age, regarding withholding and withdrawing of futile treatments in anticipation of death, or relieving symptoms close to death.
Anesthesiologists should be competent in all aspects of terminal care, including the practical and ethical aspects of withdrawing different modalities of life-sustaining treatment and the use of sedatives, analgesics, and nonpharmacologic approaches to easing the suffering of the dying process. More research is needed to provide models which should be spread in the scientific community to afford this difficult task.
当患者接近死亡时，麻醉师可能会面临棘手的情况，其中临床问题、决策过程和伦理问题通常相互关联且相互依赖。本文旨在评估最近关于晚期癌症患者麻醉学作用的文献。
临终患者的姑息性镇静、重症监护室的临终问题以及晚期癌症患者的疼痛控制一直是最近研究的主题。所有这些问题都表明，麻醉师将成为生命末期疼痛和症状控制领域的专家。重症监护室中常见临终关怀问题，决策过程需要了解和管理患者的意愿、过去和预期的未来生活质量、疾病的严重程度和预后、患者的年龄，以及在预期死亡时是否停止和撤回无效治疗，或缓解接近死亡时的症状。
麻醉师应胜任临终关怀的各个方面，包括停止不同维持生命治疗方式的实际和伦理方面，以及使用镇静剂、镇痛药和非药物方法来减轻临终过程中的痛苦。需要进一步的研究来提供模型，这些模型应该在科学界中传播，以完成这项艰巨的任务。
