RESUMO
In times of reduced mortality from myocardial infarction and ageing of the population, the number of patients suffering from chronic heart failure continues to rise. In spite of optimal cardiological treatment, many patients suffer from dyspnoea. The use of commonly used drugs in palliative care such as opioids for the relief of dyspnoea is uncommon in this group of patients. We conducted a limited systematic literature research in order to find out if there is evidence for the use of any systemic pharmacological substance for the symptomatic relief of dyspnoea in chronic heart failure patients. Three randomised controlled trials with opioids could be identified. The quality of the identified studies does not support the avoidance of the use of opioids in patients with chronic heart failure to relieve dyspnoea. But further studies are recommended to support the use of opioids in patients with chronic heart failure for relief of breathlessness to improve the quality of life of this growing population.
Assuntos
Analgésicos Opioides/uso terapêutico , Dispneia/tratamento farmacológico , Medicina Baseada em Evidências , Insuficiência Cardíaca/complicações , Cuidados Paliativos/métodos , Analgésicos Opioides/efeitos adversos , Ensaios Clínicos Controlados como Assunto , Dispneia/etiologia , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/mortalidade , Humanos , Morfina/efeitos adversos , Morfina/uso terapêutico , Análise de SobrevidaAssuntos
Sedação Consciente/ética , Ética Médica , Eutanásia Ativa/ética , Dor Intratável/terapia , Cuidados Paliativos/ética , Estresse Psicológico , Assistência Terminal/ética , Idoso , Comparação Transcultural , Eutanásia Ativa/legislação & jurisprudência , Alemanha , Humanos , Masculino , Midazolam , Cuidados Paliativos/legislação & jurisprudência , Direito a Morrer/ética , Direito a Morrer/legislação & jurisprudência , Medição de Risco/ética , Medição de Risco/legislação & jurisprudência , Assistência Terminal/legislação & jurisprudênciaRESUMO
In neurology, paroxysmal syndromes are well-known, eg, as manifestations of multiple sclerosis. We report a patient with meningeal carcinomatosis, who presented with therapy-refractory nausea and vomiting. The clinical suspicion of a paroxysmal syndrome prompted a trial of carbamazepine, which resulted in complete cessation of the symptoms. In cancer patients with central nervous system (CNS) involvement and therapy-refractory symptoms with sudden onset, carbamazepine treatment should be considered.
Assuntos
Antieméticos/uso terapêutico , Carbamazepina/uso terapêutico , Carcinoma/secundário , Neoplasias Meníngeas/secundário , Náusea/tratamento farmacológico , Vômito/tratamento farmacológico , Adulto , Anticonvulsivantes/uso terapêutico , Neoplasias da Mama , Carcinoma/tratamento farmacológico , Resistência a Medicamentos , Evolução Fatal , Feminino , Humanos , Neoplasias Meníngeas/tratamento farmacológico , Náusea/etiologia , Síndrome , Vômito/etiologiaRESUMO
Implementation of hospital-based palliative care team is a new subject in German-speaking areas, especially in university hospitals. Our Section of Palliative Care was subsequently built up to a 12-bed palliative care unit, a home-based, and a hospital-based palliative care team. Analysis of the implementation strategies, development of the working profile, and documentation of the hospital-based palliative care team were done. During the first 2 years, quality and number of inquiries for palliative care increased significantly. In our opinion, a high degree of expertise, involvement of the nursing staff, and personal contact play a key role for a successful implementation of a palliative care team in a large university hospital.