Terminale sedatie met midazolam bij patiënten in de huisartsenpraktijk: Een exploratief onderzoek

Blanker MH, Thiele M, Van der Velden PC. Terminal sedation using midazolam in general practice patients. An exploratory investigation. Huisarts Wet 2006;49(3):129-35. Aim To explore situations in which terminal sedation with midazolam is applied in general practice. Methods We performed a qualitative study among 18 GPs who applied terminal sedation in one or more cases in the southwest of the Netherlands. Twenty-six cases were described in detail during a semi-structured interview that was transcribed and analysed by two researchers. Results Patients’ wishes with regard to end-of-life (including euthanasia) were discussed in most cases. Indications for midazolam included refractory and non-refractory symptoms and family or patients’ emotional distress. Midazolam was administered for 8 days or less, resulting in light to deep sedation. It had no sedative effect in two cases. The GPs discussed a possible life-shortening effect in 11 cases beforehand and felt that midazolam may have shortened life in 10 cases. In one case, shortening of life was one of the aims of the GP. Discussion The indications for terminal sedation with midazolam in general practice are manifold and not restricted to refractory symptoms. Midazolam is usually administered for a short period. Terminal sedation was offered as an alternative to euthanasia in a number of cases. In one case, the distinction between euthanasia and terminal sedation was blurred due to the treatment-aim of the GP (hastening death).