Journal Article Annotations
2022, 2nd Quarter
Annotations by Barbara Lubrano di Ciccone, MD and R Garrett Key, MD
The use of dexmedetomidine appears safe for analgesia control in combination with opioids for palliative care patients. Dexmedetomidine provides “arousable sedation” without confusion allowing medical staff and family to communicate with patients. In addition, other promising properties of dexmedetomidine have been found in the amelioration of delirium, dyspnea, vomiting, shivering, sleep disorder, dystonia, and cough.
Strength and weaknesses:
This article also provides a thorough review of the pharmacological property of dexmedetomidine as well as its effect on several system organs. The authors primarily had to rely on case reports and one uncontrolled cohort study. Evidence came from different fields of medicine, and the authors did not include a systematic review methodology. Utilizing additional databases (e.g., Embase) may have revealed more relevant publications.
C-L psychiatrists often aid in the management of agitation and delirium in critical care settings. The use of dexmedetomidine could prove beneficial in the management of agitation and pain without overly compromising quality of life in terminally ill patients. In particular, patients remain arousable and communicative. The ability to be communicative is especially important in end-of-life care because it allows the patient to have important and meaningful interactions with their family and loved ones.
Out of a list of common end-of-life (EOL) concerns, caregiver proxies ranked the ability to control their loved one’s pain as the most important. Clean, safe, and comfortable facilities along with the presence kind and sympathetic providers were the next most important aspects of EOL care. These concerns were considered more important than spiritual concerns, place of death, or access to high quality life-extending treatments.
Strength and weaknesses:
The samples were drawn from a variety of different countries, and the sample size was sufficiently large to produce a dataset to support high quality analysis. Limitations include that the report posed hypothetical rather than real-world choices and that the responses were from caregiver proxies rather than the actual patients.
Prioritization of pain management in EOL care is critical and may be the most important aspect of EOL care for most people.