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General Operational Topics

Next Reply: Re:Phenobarbital use in Palliative Sedation
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Post Phenobarbital use in Palliative Sedation
Author: jkiser
Date: Aug 25, 2011 4:46 pm
We are currently in the process of developing a Palliative Sedation policy and Hospice Phamacia was contacted to inquire about pheonbarbital titration parameters. They stated it is not recommended for PC sedation and the only recommendation they gave was for PO, PR or SQ every 2 hours as needed. I have seen this used in other facilities PC sedation policies so I was wondering if anyone has heard that this is not recommended. I was also wondering if anyone knew where to find reference material concerning the use of phenobarbital for this purpose.

Thank you!
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Re:Phenobarbital use in Palliative Sedation (by mrabow on 08/30/2011)
There has been little direct comparisons among the agents commonly used in Palliative Sedation. Certainly, barbituates (including IV phenobarbital) are used. However, midazolam is probably the most widely used. In practical terms, most internists in the US probably have more experience with the benzodiazempines than with barbituates.

You might have a look at the Lo paper from our series Perspectives on Care at the Close of Life.

http://jama.ama-assn.org/content/294/14/1810.abstract

His paper is a nice summary of many of the issues around Palliative Sedation.

Best,
Michael W. Rabow, MD
Associate Director
UCSF PLCL
San Francisco, CA

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