Introduction: Sedation is a medical procedure used to palliate symptoms, refractory to standard treatment, by intentionally clouding patient’s consciousness. A recent review of literature of the last ten years shows that percentage of terminal pts followed at home, in hospital or in hospice, who needed pharmacological sedation in order to relieve refractiry physical or psychic symptoms, varies between 1% and 72% up to the average of 25%. In this study we evaluate such data by the light of the experience of Fondazione F.A.R.O.-Onlus, wich follows pts at home and in hospice.
Patients and methods: During 2001 the Fondazione F.A.R.O. -à Onlus followed 726 pts with advanced cancer, according to palliative care principles. Intentionally sedated pts with drugs were 41 (5.6%). Among these, 51.2% reached a deep level of sedation (no answer to any kind of painful stings). The most frequent causes of sedation were agitation (37.5%), pain (20.3%), dyspnoea (18.8%) and emesis (12.5%). 77% and 62.5% of sedated pts, respectively for pain and for emesis, had the symptoms evaluated 2 or 3 in the ‘‘TIQ’’ scale already during the first visit. 3 pts (7.3%), two of whom in hospice, were sedated for refractory existential distress and in one of these cases was recorded a suicidal attempt. In 9 pts (22%) depression in remote pathological anamnesis, therefore not reactive to cancer, was found out. The average number of hours of survival since beginning of sedation to death was 68.64.
Conclusions: The experience of the Fondazione F.A.R.O.- Onlus generally confirms data of literature and underlines that pharmacological sedation in palliative care is suitable in a limited number of pts. Psychiatric affections such as depression in remote pathological anamnesis and suffering for important pain or emesis at the beginning of the treatment would be considered with attention, because symptoms could develop in the direction of a possible refractoriness.