A Case Whose Delirium Improved with Discontinuation of Continuous Deep Sedation Initiated for Refractory Delirium at the End Stage of Cancer
Palliative Care Research
; : 501-505, 2017.
Article
in Japanese
| WPRIM (Western Pacific)
| ID: wpr-378898
Responsible library:
WPRO
ABSTRACT
<p>Introduction:
We herein report a case whose terminal refractory delirium improved after discontinuation of continuous deep sedation for several days. Case A 57-year-old head and neck cancer woman with brain parenchymal invasion was consulted to our palliative care team for delirium accompanied by sudden abnormal behavior. Her abnormal behavior did not improve with opioid switching or drug treatment. She was diagnosed as refractory end of life delirium, and her family wanted her to be sedated. We started intermittent sedation with midazolam and then shifted to continuous deep sedation. Several days later, her family expressed the conflict of continuing sedation. Ten days later we stopped sedating her according to her family’s will. She awoke from deep sedation and her abnormal behavior disappeared, although there was mild consciousness disturbance. The patient died 2 months later while maintaining communication with her family.Discussion:
Cessation of various drugs which may provoke delirium is considered to be one of the causes of delirium improvement in this case. The guidelines of the Japanese Society of Palliative Medicine do not clearly state the criteria for suspension of deep sedation other than confirming the feelings of family members. A criterion for withdrawal of sedation should be discussed based on higher evidence level.</p>
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Database:
WPRIM (Western Pacific)
Type of study:
Practice guideline
/
Qualitative research
Language:
Japanese
Journal:
Palliative Care Research
Year:
2017
Document type:
Article