Occasionally is cancer pain refractory to the analgesic therapies. We offered in the last 6 years the option of palliative sedation for these patient. Palliative sedation was only done at the explicit request of the well informed conscious palliatieve terminal patient.
Material and methods: The files of all the 25 palliative sedated patients are analysed for the type of refractory symptoms, the duration of the sedation, the analgesic consumption, the dose of midazolam.
Results: There is a shift in physical intractable symptoms from 40% in the first 3 years to 12.5% in the last 3 years while in the same periods the existential and psychological refractory symptoms increased from 40 to 87.5%. Nine patients have chosen for intermittent sedation, the other 16 patients asked for permanent sedation. Midazolam was given in individualised doses between 15 and 450 mg/24 h. During this sedation 5 patients didn’t need any dose of strong opioids while the other 16 patients consumed a parenteral morphine equivalent dose of 30 to 3740 mg/24 h. The sedation duration was < 6 days for 80% of the patients. In 23/25 patients was the refractory symptom completely relieved. Less than 5% of our patients did need palliative sedation.
Conclusion: Palliative sedation with individualized doses of midazolam, either intermittently or permanently, is highly effective for the treatment of refractory symptoms in terminal palliative patients.