A combination of opioid, midazolam, and scopolamine (that we call “distress protocol” [DP]) is used to induce transient sedation when emergencies occur in palliative care. We wished to describe the prescription and administration of DP in terminally ill patients with either lung cancer or chronic obstructive pulmonary disease (COPD). In a retrospective study, 96 of 100 patients with cancer and 85 of 100 patients with COPD had a DP prescribed. Thirty patients with cancer and 29 with COPD received at least 1 DP. All patients receiving a DP for an appropriate indication were sedated within 30 minutes. There was no difference in survival from DP administration among patients who received it and those who did not.
LichterIHuntE. The last 48 hours of life. J Palliat Care. 1990;6(4):7–15.
3.
RadbruchLNauckFOstgatheC. What are the problems in palliative care? Results from a representative survey. Support Care Cancer. 2003;11(7):442–451.
4.
FainsingerRMillerMJBrueraEHansonJMaceachernT. Symptom control during the last week of life on a palliative care unit. J Palliat Care. 1991;7(1):5–11.
5.
ConillCVergerEHenriquezI. Symptom prevalence in the last week of life. J Pain Symptom Manage. 1997;14(6):328–331.
6.
VentafriddaVRipamontiCDe ConnoFTamburiniMCassilethBR. Symptom prevalence and control during cancer patients’ last days of life. J Palliat Care. 1990;6(3):7–11.
7.
KlinkenbergMWillemsDLvan der WalGDeegDJ. Symptom burden in the last week of life. J Pain Symptom Manage. 2004;27(1):5–13.
8.
Heyse-MooreLHRossVMulleeMA. How much of a problem is dyspnoea in advanced cancer?Palliat Med. 1991;5(2):20–26.
9.
ReubenDBMorV. Dyspnea in terminally ill cancer patients. Chest. 1986;89(2):234–236.
10.
ClaessensMTLynnJZhongZ. Dying with lung cancer or chronic obstructive pulmonary disease: insights from SUPPORT. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc. 2000;48(5 suppl):S146–S153.
11.
NauckFAlt-EppingB. Crises in palliative care--a comprehensive approach. Lancet Oncol. 2008;9(11):1086–1091.
12.
SchrijversDvan FraeyenhoveF. Emergencies in palliative care. Cancer J. 2010;16(5):514–520.
13.
JenningsALDaviesANHigginsJPBroadleyK. Opioids for the palliation of breathlessness in terminal illness. Cochrane Database Syst Rev. 2001;(4):CD002066.
14.
BennettMLucasVBrennanMHughesAO’DonnellVWeeB. Using anti-muscarinic drugs in the management of death rattle: evidence-based guidelines for palliative care. Palliat Med. 2002;16(5):369–374.
15.
SimonSTHigginsonIJBoothSHardingRBauseweinC. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev. 2010;(1):CD007354.
16.
ZeppetellaGRibeiroMD. Opioids for the management of breakthrough (episodic) pain in cancer patients. Cochrane Database Syst Rev. 2006;(1):CD004311.
17.
du CouedicLMorelVTrehelloLTrehonyARobertMSandronD. [Palliative care for patients with COPD: a challenge]. Rev Mal Respir. 2012;29(9):1088–1094.
18.
ChernyNI. Sedation for the care of patients with advanced cancer. Nat Clin Pract Oncol. 2006;3(9):492–500.
19.
ZeppetellaGRibeiroMD. Pharmacotherapy of cancer-related episodic pain. Expert Opin Pharmacother. 2003;4(4):493–502.
20.
BulachRMylesPSRussnakM. Double-blind randomized controlled trial to determine extent of amnesia with midazolam given immediately before general anaesthesia. Br J Anaesth. 2005;94(3):300–305.
21.
DundeeJWWilsonDB. Amnesic action of midazolam. Anaesthesia. 1980;35(5):459–461.
22.
RevesJGFragenRJVinikHRGreenblattDJ. Midazolam: pharmacology and uses. Anesthesiology. 1985;62(3):310–324.
23.
WeeBHillierR. Interventions for noisy breathing in patients near to death. Cochrane Database Syst Rev. 2008;(1):CD005177.
24.
CurranHVSchifanoFLaderM. Models of memory dysfunction? A comparison of the effects of scopolamine and lorazepam on memory, psychomotor performance and mood. Psychopharmacology (Berl). 1991;103(1):83–90.
25.
WagnerBKO’HaraDA. Pharmacokinetics and pharmacodynamics of sedatives and analgesics in the treatment of agitated critically ill patients. Clin Pharmacokinet. 1997;33(6):426–453.
26.
RennerUDOertelRKirchW. Pharmacokinetics and pharmacodynamics in clinical use of scopolamine. Ther Drug Monit. 2005;27(5):655–665.
27.
GoreJMBrophyCJGreenstoneMA. How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax. 2000;55(12):1000–1006.
28.
ClaessensPMentenJSchotsmansPBroeckaertB. Palliative sedation: a review of the research literature. J Pain Symptom Manage. 2008;36(3):310–333.
29.
Grijol-CariouALGoupilFHubaultPJouanneauJ. [Use of sedation in the palliative care situation by respiratory physicians]. Rev Mal Respir. 2014;31(1):48–56.
30.
MaltoniMPittureriCScarpiE. Palliative sedation therapy does not hasten death: results from a prospective multicenter study. Ann Oncol. 2009;20(7):1163–1169.
