• Acta Anaesthesiol Scand · May 2024

    How should respiratory depression and loss of airway patency be handled during initiation of palliative sedation?

    • FredheimOlav Magnus SOMSDepartment of Palliative Medicine, Division of Surgery, Akershus University Hospital, Lørenskog, Norway.Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Solveig K Torvund, Lisbeth Thoresen, and Morten Magelssen.
    • Department of Palliative Medicine, Division of Surgery, Akershus University Hospital, Lørenskog, Norway.
    • Acta Anaesthesiol Scand. 2024 May 1; 68 (5): 675680675-680.

    BackgroundLoss of airway patency has been reported during initiation of palliative sedation. In present guidelines the loss of airway patency during initiation of palliative sedation is not addressed. Airway patency can be restored by jaw thrust/chin lift or placing the patient in the recovery position.AimA structured ethical analysis of how respiratory depression and loss of airway patency during initiation of palliative sedation should be handled. The essence of the dilemma is whether it is appropriate to apply simple non-invasive methods to restore airway patency in order to avoid the patient's immediate death.DesignA structured analysis based on the four principles of healthcare ethics and stakeholders' interests.ResultsBeneficence and autonomy support a decision not to regain airway patency whereas non-maleficence lends weight to a decision to restore airway patency. Whether the proportionality criterion of the principle of double effect is met depends on the features of the individual case. The ethical problem appears to be a genuine dilemma where important values and arguments point to different conclusions.ConclusionWhether to restore airway patency when the airway is obstructed during initiation of palliative sedation will ultimately be based on clinical judgment taking into account both any known patient preferences and relevant clinical information. There are strong arguments favoring both options in this clinical and ethical dilemma. The fact that a clear and universal recommendation cannot be made does not imply indifference regarding what is the clinically and ethically best option for each individual patient.© 2024 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

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