Dexmedetomidine Facilitates the Withdrawal of Ventilatory Support in Palliative Care

Abstract

WITHDRAWAL of ventilatory support in the setting of a terminal illness presents the challenge to the physician of maintaining the comfort of the patient and optimizing sedation and analgesia for the time that the patient has remaining to be with his or her family and friends. Opiates and benzodiazepines are most commonly used for terminal palliation, but this combination of medications has the disadvantage of depressing ventilatory drive and airway reflexes to the degree that it may hasten the patient's death. This problem has been discussed in medical and legal literature invoking the medieval theological concept of the rule of double effect to assist physicians who are faced with the need to make the distinction between euthanasia and appropriate symptom relief in the terminally ill. 1,2 Dexmedetomidine (Abbott Laboratories, Abbott Park, IL), with its highly selective α 2 agonism, provides physicians with another pharmacologic treatment option that addresses many of the possible sources of end-of life distress, 3 with less of a problem with the double effect. We report on the care of a patient where provision of palliative care and withdrawal of ventilatory support was optimized by the use of a dexmedetomidine infusion.