• Tatsuya Morita, Yoshikazu Chinone, Masayuki Ikenaga, Makoto Miyoshi, Toshimichi Nakaho, Kenji Nishitateno, Mitsuaki Sakonji, Yasuo Shima, Kazuyuki Suenaga, Chizuko Takigawa, Hiroyuki Kohara, Kazuhiko Tani, Yasuo Kawamura, Tatsuhiro Matsubara, Akihiko Watanabe, Yasuo Yagi, Toru Sasaki, Akiko Higuchi, Hideyuki Kimura, Hirofumi Abo, Taketoshi Ozawa, Yoshiyuki Kizawa, Yosuke Uchitomi, and Japan Pain, Palliative Medicine, Rehabilitation, and Psycho-Oncology Study Group.
• Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatabara-cho, Hamamatsu, Shizuoka 433-8558, Japan.
• J Pain Symptom Manage. 2005 Oct 1;30(4):320-8.

AbstractAlthough palliative sedation therapy is often required in terminally ill cancer patients, its efficacy and safety are not sufficiently understood. The primary aims of this multicenter observational study were to 1) explore the efficacy and safety of palliative sedation therapy, and 2) identify the factors contributing to inadequate symptom relief and complications, using a prospective study design, clearly defined measurement methods, and a consecutive sample from 21 specialized palliative care units in Japan. A sample of 102 consecutive adult cancer patients who received continuous deep sedation were enrolled. Physicians prospectively evaluated the intensity of patient symptoms, communication capacity, respiratory rate, and complications related to sedation. Symptoms were measured on the Agitation Distress Scale, the Memorial Delirium Assessment Scale, and the ad hoc symptom severity scale (0 = no symptoms, 1 = mild and tolerable symptoms, 2 = intolerable symptoms for less than 15 minutes in the previous one hour, and 3 = intolerable symptoms continuing for more than 15 minutes in the previous one hour). Inadequate symptom relief was defined as presence of hyperactive delirium (item 9 of the Memorial Delirium Assessment Scale >or=2) or grade 2 or 3 symptom intensity 4 hours after sedation. The degree of communication capacity was measured on the Communication Capacity Scale. Palliative sedation therapy succeeded in symptom alleviation in 83% of the cases. Median time elapsed before patients initially had one continuous hour of deep sedation was 60 minutes, but 49% of the patients awakened once after falling into a deeply sedated state. The percentage of patients who were capable of explicit communication decreased from 40% before sedation to 7.1% 4 hours after sedation, and the mean Communication Capacity Score significantly decreased to the level of 15 points (P < 0.001). The respiratory rates did not significantly decrease after sedation (18 +/- 9.0 to 16 +/- 9.4/min, P = 0.62), but respiratory and/or circulatory suppression (respiratory rate

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