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Anesth Analg 2005;101:611-612
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000159014.71321.A2

LETTER TO THE EDITOR

Existential Distress and Palliative Sedation

Paul Rousseau, MD

Geriatrics and Extended Care; Palliative Care; VA Medical Center; Phoenix, AZ; palliativedoctor{at}aol.com

To the Editor:

I read with interest the article by Perry Fine (1). Dr. Fine justly addressed existential distress and palliative sedation (he prefers to label it as total sedation), given that existential suffering can be just as consequential and debilitating as physical suffering. However, he did not discuss a valuable subset of palliative sedation that can be used for existential distress, respite sedation (2,3). Respite sedation is a form of palliative sedation in which patients are deeply sedated for a predetermined amount of time (usually 24 to 48 h), and then reawakened to assess the extent of symptomatic improvement and the need for further sedation. Because many dying patients are afflicted with existential turmoil that engenders fear, fatigue, and insomnia, respite sedation may break a cycle of sleep deprivation and existential distress and allow such patients the opportunity to regain psychological strength and assuage the existential issues that precipitated the need for palliative sedation. Respite sedation also allows second-guessing and reassessment by health care providers, patients, and family members, negating the sense of overwhelming finality and guilt that may occur with continuous deep sedation.

Footnotes

Dr. Fine does not wish to respond.

References

  1. Fine PG. The evolving and important role of anesthesiology in palliative care. Anesth Analg 2005;100:183–8.[Abstract/Free Full Text]
  2. Rousseau P. Existential suffering and palliative sedation in terminal illness. Prog Palliat Care 2002;10:222–4.
  3. Rousseau P. Existential suffering and palliative sedation: A brief commentary and a proposal for clinical guidelines. Am J Hosp Palliat Care 2001;18:226–8.[Free Full Text]



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[Abstract] [Full Text] [PDF]

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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press