2018 Volume 55 Issue 2 Pages 177-181
We experienced managing the symptoms of two adolescents with cancer (an 18 year old with epithelial sarcoma and a 17 year old with rhabdomyosarcoma) who received continuous intravenous infusion of midazolam at home to relieve end-of-life distress. We obtained written informed consent not only from their families but also from the patients themselves. The estimated prognosis using the Palliative Prognostic Index was less than 3 weeks in both patients. The symptoms that required sedation were restlessness in end-of-life distress, insomnia, and anxiety in one patient, and refractory thirst, nausea, and vomiting in the other patient. The starting doses of midazolam were 3 and 1.25 mg/h, and we increased the flow velocity by 20 to 30% until pain is relieved if there is no respiratory depression. We succeeded in symptom management after increasing the doses by twofold. The duration of continuous sedation was less than 2 weeks and there were no drug-related lethal complications. Even at home, sedation by continuous intravenous injection of midazolam is considered safe if the medical staff closely cooperate with each other.
