Abstract
Options for the careful use of benzodiazepines in end-of-life care may be limited by several factors, including local availability and experience. Fifty-seven patients treated with midazolam for palliative sedation therapy (PST) in end-of-life care were matched by diagnosis, sex, and age with 57 patients treated with flunitrazepam. Comparisons included the number of PST interventions required, maintenance of consciousness, length of life remaining, and responses for a range of symptoms, using the patient's perspective where possible. Both benzodiazepines improved symptoms in all categories considered, with flunitrazepam appearing to be more effective. Patients on flunitrazepam survived longer after the initiation of PST (P = 0.01), remained conscious for longer (P = 0.019), and required fewer adjuvant treatment interventions (P = 0.008). There is a potential concern that patients may feel trapped by midazolam and not be able to communicate this.
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