Dexmedetomidine for Sedation during Withdrawal of Support.

Palliative Care Pub Date : 2015-08-25 eCollection Date: 2015-01-01 DOI:10.4137/PCRT.S27954
Chris O'Hara, Robert F Tamburro, Gary D Ceneviva
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引用次数: 0

Abstract

Agents used to control end-of-life suffering are associated with troublesome side effects. The use of dexmedetomidine for sedation during withdrawal of support in pediatrics is not yet described. An adolescent female with progressive and irreversible pulmonary deterioration was admitted. Despite weeks of therapy, she did not tolerate weaning of supplemental oxygen or continuous bilevel positive airway pressure. Given her condition and the perception that she was suffering, the family requested withdrawal of support. Despite opioids and benzodiazepines, she appeared to be uncomfortable after support was withdrawn. Ketamine was initiated. Relief from ketamine was brief, and its use was associated with a "wide-eyed" look that was distressing to the family. Ketamine was discontinued and a dexmedetomidine infusion was initiated. The patient's level of comfort improved greatly. The child died peacefully 24 hours after initiating dexmedetomidine from her underlying disease rather than the effects of the sedative.

右美托咪定(Dexmedetomidine)用于撤出支持期间的镇静。
用于控制临终痛苦的药物都会产生令人头疼的副作用。在儿科使用右美托咪定在撤除支持过程中进行镇静的情况尚未见报道。患者是一名青少年女性,肺部功能进行性和不可逆转地恶化。尽管已经接受了数周的治疗,但她仍无法耐受断开补充氧气或持续双水平气道正压。考虑到她的病情和对她痛苦的感知,家人要求停止对她的支持。尽管使用了阿片类药物和苯二氮卓类药物,但在停止支持后,她仍显得很不舒服。于是开始使用氯胺酮。氯胺酮的缓解作用很短暂,而且使用氯胺酮时会出现 "瞪大眼睛 "的表情,这让家人感到不安。停用氯胺酮后,开始输注右美托咪定。患者的舒适度大大提高。使用右美托咪定 24 小时后,患儿因潜在疾病而非镇静剂的影响安详离世。
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来源期刊
自引率
0.00%
发文量
0
审稿时长
15 weeks
期刊介绍: Palliative Care and Social Practice is an international, peer-reviewed, open access journal that publishes articles on all aspects of palliative care. It welcomes articles from symptom science, clinical practice, and health services research. However, its aim is also to publish cutting-edge research from the realm of social practice - from public health theory and practice, social medicine, and social work, to social sciences related to dying and its care, as well as policy, criticism, and cultural studies. We encourage reports from work with under-represented groups, community development, and studies of civic engagement in end of life issues. Furthermore, we encourage scholarly articles that challenge current thinking about dying, its current care models and practices, and current understandings of grief and bereavement. We want to showcase the next generation of palliative care innovation research and practice - in clinics and in the wider society. Relaunched in July 2019. Partnered with Public Health Palliative Care International (PHPCI) (Title 2008-2018: - Palliative Care: Research and Treatment)
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