Of sedating

20 Jan

As oncologists, we have a clinical and ethical responsibility to relieve the suffering of our patients as they approach the end of life.In situations of otherwise intractable suffering, sedation, to induce a state of decreased or absent awareness (unconsciousness), has emerged as a critically important therapeutic option to relieve the burden of otherwise intolerable distress [1, 2].This underscores the importance of patient evaluation by a clinician who is expert in the relief of symptoms before resorting to this therapeutic option.Conversely, injudicious withholding of sedation in the management of refractory distress occurs when clinicians defer the use of sedation excessively while persisting with other therapeutic options that do not provide adequate relief.Published by Oxford University Press on behalf of the European Society for Medical Oncology.

In the meantime, we need not be paralyzed by uncertainty.Sound procedural guidelines, such as checklists, can reduce the risk of adverse outcomes in medicine [24, 25].Procedural guidelines for the use of sedation in the management of refractory sedation at the end of life can help guide clinical practice to ensure sedation is used in appropriate setting and to help avoid pitfalls in practice.General anaesthesia undoubtedly allows MRI to be carried out in anxious children, but sedation is sometimes seen as an acceptable alternative, particularly in the United States.Conscious sedation is impractical in a noisy environment and deep sedation is necessary,1-1 1-2 in spite of official disapproval.1-3 Deep sedation usually involves a bolus of an oral hypnotic, which may need to be topped up with an intravenous tranquilliser or opioid.