Should we include monitors to improve assessment of awareness and pain in unconscious palliatively sedated patients? A case report

Background: Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. Case presentation: A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, an...

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Published inPalliative medicine Vol. 33; no. 6; pp. 712 - 716
Main Authors Six, Stefaan, Laureys, Steven, Poelaert, Jan, Bilsen, Johan, Theuns, Peter, Musch, Liza, Deschepper, Reginald
Format Journal Article Web Resource
LanguageEnglish
Published London, England SAGE Publications 01.06.2019
Sage Publications Ltd
Subjects
Online AccessGet full text
ISSN0269-2163
1477-030X
1477-030X
DOI10.1177/0269216319835149

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Abstract Background: Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. Case presentation: A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions. Case management: The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor). Case outcome: The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise. Conclusion: This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.
AbstractList Background:Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question.Case presentation:A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions.Case management:The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor).Case outcome:The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise.Conclusion:This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.
Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions. The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor). The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise. This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.
Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question.BACKGROUNDAwareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question.A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions.CASE PRESENTATIONA woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions.The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor).CASE MANAGEMENTThe decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor).The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise.CASE OUTCOMEThe patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise.This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.CONCLUSIONThis case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.
Background: Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. Case presentation: A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions. Case management: The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor). Case outcome: The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise. Conclusion: This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.
Author Deschepper, Reginald
Six, Stefaan
Laureys, Steven
Bilsen, Johan
Theuns, Peter
Musch, Liza
Poelaert, Jan
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10.1177/0269216311425421
10.1371/journal.pone.0147720
10.1186/s12904-018-0316-2
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pain measurement
deep sedation
unconsciousness
patient monitoring
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Ramsay, Savege, Simpson 1974; 2
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Snippet Background: Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question....
Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. A woman in...
Background:Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into...
Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into...
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SubjectTerms Accidents
Aged, 80 and over
Analgesia
Anesthesia
Aphasia
Awareness - physiology
Case management
Case reports
Chronic pain
deep sedation
Deep Sedation - methods
Discomfort
Drugs
Fatal Outcome
Feasibility
Female
Hemiplegia
Human health sciences
Humans
Hypnotics and Sedatives - therapeutic use
Monitoring, Physiologic - instrumentation
Monitoring, Physiologic - methods
Nausea
Pain
Pain - diagnosis
Pain - drug therapy
Pain management
Pain Management - methods
pain measurement
Palliative care
Palliative Care - methods
Paralysis
Patient admissions
Patient assessment
patient monitoring
Public health, health care sciences & services
Santé publique, services médicaux & soins de santé
Sciences de la santé humaine
Sedation
Stroke
Suffering
Unconsciousness
Unconsciousness - physiopathology
Vomiting
Title Should we include monitors to improve assessment of awareness and pain in unconscious palliatively sedated patients? A case report
URI https://journals.sagepub.com/doi/full/10.1177/0269216319835149
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