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

Author:

Six Stefaan1ORCID,Laureys Steven2,Poelaert Jan3,Bilsen Johan1,Theuns Peter14,Musch Liza1,Deschepper Reginald1

Affiliation:

1. Mental Health and Wellbeing Research Group, Department of Public Health, Vrije Universiteit Brussel, Jette, Belgium

2. Coma Science Group, Cyclotron Research Centre and Neurology Department, University Hospital of Liège, University of Liège, Liège, Belgium

3. Department of Anesthesiology and Perioperative Medicine, Vrije Universiteit Brussel, Jette, Belgium

4. Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Brussels, Belgium

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.

Funder

Fonds Wetenschappelijk Onderzoek

Publisher

SAGE Publications

Subject

Anesthesiology and Pain Medicine,General Medicine

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