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Paliativna oskrba ob koncu življenja, v katerem se pojavijo znaki pričetka umiranja s pešanjem vitalnih organov in se končajo s smrtjo, je pomemben del celostne paliativne oskrbe. Včasih, ob izredno težkih refraktarnih simptomih napredovale bolezni, je lahko primerna tudi paliativna sedacija. Paliativna sedacija je medicinski postopek, kjer je potrebno strogo upoštevati protokol izvedbe, in slediti etično moralnim vidikom in nikakor prekoračiti črte evtanazije. Paliativno sedacijo je potrebno skrbno načrtovati, se pogovoriti z bolnikom, svojci in s celotnim timom, ki bolnika oskrbuje (zdravniki in negovalno osebje), ga ustrezno dokumentirati in nadzorovati. Pomemben je multidisciplinarni pristop, ko vsak od vključenih zdravnikov specialistov in negovalnega osebja osvetli svoj vidik. V prispevku smo opisali klinični primer bolnice, ki se je zaradi refraktarnega simptoma sprva odločila za paliativno sedacijo, kasneje pa je svojo odločitev spremenila. Pri opisanem primeru s standardnimi učinkovinami sprva nismo uspeli doseči ustrezne globine paliativne sedacije, zato smo se odločili uporabiti deksmedetomidin. Z deksmedetomidinom smo dosegli plitvo sedacijo, ki je bolnici olajšala trpljenje do te mere, da se je tudi odločila za prekinitev paliativne sedacije. Deksmedetomidin je učinkovita in varna učinkovina, ki si išče svoje mesto tudi v paliativni medicini. V literaturi so objavljeni samo posamezni prikazi kliničnih primerov in pregledov področja, ni pa še objavljene randomizirane raziskave. V prihodnosti se taka raziskava načrtuje.
Palliative end-of-life care, in which signs of dying with the deterioration of vital organs develope and end with death, is a particularly important part of comprehensive palliative care. Palliative sedation must strictly adhere to the ethical aspects and in no way goes beyond the lines of euthanasia. Sedation should be carefully planned and discussed with the patient, relatives and other medical specialists. A multidisciplinary approach is imperative. Each of the specialists of the multidisciplinary team can illuminate their own aspect. At the Institute of Oncology Ljubljana, medical specialists from various disciplines are engaged in palliative medicine and palliative sedation. This paper describes the clinical case of a patient who initially decided for the palliative sedation. Since it was inpossible to achieve adequate sedation depth with standard agents, we decided to use dexmedetomidine. With dexmedetomidine shallow sedation was achieved. Dexmedetomidine is an effective and safe medication that seeks its place in palliative medicine. Only some case reports of this field have been published, but there is no randomised study yet published. We are planning such a study in the future.
How to Cite
Potočnik, I., & Stražišar, B. (2023). Dexmedetomidine use for palliative sedation: a case report. Onkologija : A Medical-Scientific Journal, 27(2), 72–75. https://doi.org/10.25670/oi2023-012on
Issue SectionCase Reports
LicenseCopyright (c) 2023 Iztok Potočnik, Branka Stražišar
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