Sedation with Ketamine to Catch Up with a Failed Sedation using Midazolam
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 16, Issue 1
Abstract
Background: The problem of treatment-refractory symptoms is common in palli-ative care practice. In such circumstances, it is possible to sedate with midazolam. We propose here the case of a patient who benefited from deep sedation with ketamine as a rescue of a failed sedation with midazolam for refractory dyspnea.Case presentation: Mrs. X, 76 years, with a weight of 50 Kg, was known since 2008 for breast cancer with lungs and liver metastasis. Only palliative care was delivered since one year. She was hospitalized in the geriatric department for pulmonary sepsis with bilateral pleural effusion. Because of a refractory dyspnea, it was decided, after discus-sion with the patient and his family, to start deep sedation using midazolam. Despite important midazolam doses, the comfort state of the patient was considered insufficient. With the support of the Mobile Palliative Care Team, deep sedation with ketamine was successfully carried out as a catch-up. Discussion: It appears from experience that ketamine seems to be a good drug al-ternative in the event of the failure of deep sedation with midazolam, and especially a much simpler and more secure alternative to put in place in a routine care service than propofol sedation.Conclusion: Ketamine appears to be a good alternative in case of midazolam sedation failure. This option is secure, manageable and easily accessible, unlike propofol. It is worth considering the conduct of clinical trials, given the interest of the palliative medi-cal community in this therapeutic alternative in situations of midazolam sedation failure.
Authors and Affiliations
Raphaël Alluin, Johann Laangry, Elodie Andrée
Keywords
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- EP ID EP590790
- DOI 10.26717/BJSTR.2019.16.002791
- Views 130
- Downloads 0
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