SEDATION FOR UNCONTROLLED SYMPTOMS IN A SOUTH-AFRICAN HOSPICE

The need to sedate terminally ill patients for uncontrolled symptoms h as been previously documented in a few reports. A retrospective consec utive chart review was undertaken at a hospice in Cape Town, South Afr ica, to develop an understanding of the local experience and assess th e potential for improved patient management. Twenty-three of seventy-s ix (30%) patients received sedating therapies: twenty patients for del irium, two patients for delirium and dyspnea, and one patient for dysp nea alone. Fourteen patients were sedated with a continuous subcutaneo us infusion of midazolam, seven patients with intermittent doses of be nzodiazepines, and two patients with chlorpromazine and lorazepam. The mean midazolam dose was 29 mg per day (median 30 mg; range 15-60 mg p er clay). Patients were sedated on average 2.5 days before death (medi an 1 day; range 4 hours-12 days). The mean equivalent daily dose of pa renteral morphine in the last week of life showed significantly higher mean for the sedated group, as compared to the nonsedated group. Ther e was minimal investigation of reversible causes for delirium, none of the patients underwent an opioid rotation, and the opioid dose was se ldom decreased. None of the patients received parenteral hydration. Th e prevalence for the use of sedating treatment is consistent with the range of other literature reports. Nevertheless, the wide disparity in the reported prevalence of these problems, and the ethical concerns r aised by the relative frequency of this sedative approach, cannot be i gnored. (C) U.S. Cancer Pain Relief Committee, 1998.