Department of Palliative Medicine, Akershus University Hospital, Lørenskog, Norway.
Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Acta Anaesthesiol Scand. 2020 Oct;64(9):1319-1326. doi: 10.1111/aas.13665. Epub 2020 Jul 15.
The anesthetic propofol is often mentioned as a drug that can be used in palliative sedation. The existing literature of how to use propofol in palliative sedation is scarce, with lack of information about how propofol could be initiated for palliative sedation, doses and treatment outcomes.
To describe the patient population, previous and concomitant medication, and clinical outcome when propofol was used for palliative sedation.
A retrospective study with quantitative and qualitative data. All patients who during a 4.5-year period received propofol for palliative sedation at the Department of palliative medicine, Akershus University Hospital, Norway were included.
Fourteen patients were included. In six patients the main indication for palliative sedation was pain, in seven dyspnoea and in one delirium. In eight of these cases propofol was chosen because of the pharmacokinetic properties (rapid effect), and in the remaining cases propofol was chosen because midazolam in spite of dose titration failed to provide sufficient symptom relief. In all patients sedation and adequate symptom control was achieved during manual dose titration. During the maintenance phase three of 14 patients had spontaneous awakenings. At death, propofol doses ranged from 60 to 340 mg/hour.
Severe suffering at the end of life can be successfully treated with propofol for palliative sedation. This can be performed in palliative medicine wards, but skilled observation and dose titration throughout the period of palliative sedation is necessary. Successful initial sedation does not guarantee uninterrupted sedation until death.
In palliative care, some patients at the end of life can reach a stage where there have been maximal analgesic and or anxiolytic treatments though without achieving comfort in the awake state. This report describes and discusses use of propofol in these infrequent cases to relieve suffering as part of palliative care.
麻醉药物异丙酚常被提及可用于姑息性镇静治疗。目前关于如何在姑息性镇静治疗中使用异丙酚的文献很少，缺乏关于如何开始使用异丙酚进行姑息性镇静、剂量和治疗结果的信息。
描述接受异丙酚姑息性镇静治疗的患者人群、既往和同时使用的药物以及临床结局。
这是一项回顾性研究，采用定量和定性数据。所有在挪威阿克什胡斯大学医院姑息医学科接受异丙酚姑息性镇静治疗的患者，在 4.5 年的时间内均被纳入研究。
共纳入 14 名患者。6 例患者的主要镇静指征是疼痛，7 例是呼吸困难，1 例是谵妄。在这些病例中，有 8 例选择异丙酚是因为其药代动力学特性（起效迅速），而在其余病例中，尽管进行了剂量滴定，咪达唑仑仍未能提供足够的症状缓解，因此选择了异丙酚。在所有患者中，通过手动剂量滴定实现了镇静和足够的症状控制。在维持阶段，14 名患者中有 3 名出现自发性觉醒。在死亡时，异丙酚剂量范围为 60 至 340 毫克/小时。
在生命末期，严重的痛苦可以通过异丙酚姑息性镇静来成功治疗。这可以在姑息医学病房进行，但在整个姑息性镇静期间需要进行熟练的观察和剂量滴定。初步镇静成功并不能保证镇静持续到死亡。
在姑息治疗中，一些生命末期的患者可能已经接受了最大剂量的镇痛和/或抗焦虑治疗，但在清醒状态下仍未感到舒适。本报告描述并讨论了在这些罕见情况下使用异丙酚来缓解痛苦，作为姑息治疗的一部分。
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