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BMC Palliative Care
Published in: BMC Palliative Care 1/2020

01-12-2020 | Care | Research article

Midazolam sedation in palliative medicine: retrospective study in a French center for cancer control

Authors: Vincent Gamblin, Vincent Berry, Emmanuelle Tresch-Bruneel, Michel Reich, Arlette Da Silva, Stéphanie Villet, Nicolas Penel, Chloé Prod’Homme

Published in: BMC Palliative Care | Issue 1/2020

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Abstract

Background

French legislation about sedation in palliative medicine evolved in 2016 with the introduction of a right to deep and continuous sedation, maintained until death. The objective was to describe midazolam sedation at the COL (Centre Oscar Lambret [Oscar Lambret Center], French regional center for cancer control), in order to establish a current overview before the final legislative changes.

Methods

Descriptive, retrospective and single-center study, concerning major patients in palliative care hospitalized from 01/01/2014 to 12/31/2015, who had been sedated by midazolam. The proven sedations (explicitly named) and the probable sedations were distinguished.

Results

A total of 54 sedations were identified (48 proven, 6 probable). Refractory symptoms accounted for 48.1% of indications, complications with immediate risk of death 46.3%, existential suffering 5.6%. Titration was performed in 44.4% of cases. Sedation was continuous until death for 98.1% of the cases. Probable sedation had a higher failure rate than proven sedation. Significant differences existed for the palliative care unit compared to other units regarding information to the patient, their consent, anticipation, mention by correspondence and carrying out titrations. When patients had already been treated with midazolam, the induction doses, initial maintenance doses, and doses at the time of death were significantly higher. For those receiving opioids, the maintenance dose at the time of death was higher. No comparison found a difference in overall survival.

Conclusions

After a sufficient follow-up has enabled teams to familiarize with this new legislation, reflection on sedation should be conducted to adapt to final recommendations.
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Metadata
Title
Midazolam sedation in palliative medicine: retrospective study in a French center for cancer control
Authors
Vincent Gamblin
Vincent Berry
Emmanuelle Tresch-Bruneel
Michel Reich
Arlette Da Silva
Stéphanie Villet
Nicolas Penel
Chloé Prod’Homme
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2020
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-020-00592-3

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