Table of Contents
- 1What Is Palliative Care or End of Life Care?
- 2Who Requires Palliative Care?
- 3What Does Palliative Care Do?
- 4When to Use Anesthesia in Palliative Care?
- 5What Considerations to Be Noted Before the Usage of Anesthesia in Palliative Care?
- 6What Are the Anesthetics Used in Palliative Care?
- 7How Is Intraoperative Care Taken During Anesthesia Administered?
- 8Is Palliative Anesthesia Beneficial or Not?
Introduction
Palliative care is the specialized medical care provided to a severely ill patient. It prevents and relieves the illness of patients going through life-threatening issues. The main motive for palliative care is to reduce disease and restore the patient's health. Palliative anesthesia does reduce the illness stress but at the cost of the patient's life. Due to sedatives, the patient is completely asleep, which inhibits the severity of the patient's condition, and the nourishment is limited.
What Is Palliative Care or End-of-Life Care?
The World Health Organization says that "palliative care is the approach that improves the quality of life of patients and their families who are facing problems associated with the life-threatening illness." It prevents and relieves problems through early detection and treatment, including physical, psychosocial, and spiritual. Pain and difficulty breathing are the two most frequently faced severe symptoms requiring palliative care.
Who Requires Palliative Care?
Palliative care is required for many diseases. The patient requirement is irrespective of age and sex and only deals with the severity of the illness. The majority of patients who need it have chronic diseases and conditions such as,
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Chronic respiratory diseases.
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Human immunodeficiency virus.
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Chronic liver diseases.
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Multiple sclerosis.
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Neurological disease.
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Congenital abnormalities.
What Does Palliative Care Do?
It aims to improve the quality of life by relieving suffering. Its primary focus is on managing the symptoms like pain, difficulty in breathing, difficulty in eating, and mental problems. The initial care starts with the earlier information gathered. Then, symptoms with laboratory tests are noted. The management of the patient's condition depends upon symptoms, so the treatment accordingly is made to follow.
When to Use Anesthesia in Palliative Care?
Anesthesia usage in palliative care is as follows:
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Anesthesia is the last step if the patient fails to respond to other treatments. If treatment fails to relieve the symptoms like pain, difficulty in breathing, and delirium, anesthetics command palliative care.
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The doctor should acknowledge the patient for using anesthesia during palliative care or before starting the treatment if cases like delirium are present.
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The doctor should also inform the caregiver of the patient about anesthesia usage. It can be used for a short time to see if the patient has eliminated the symptoms. Awakening from the anesthesia shows the result.
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Continuous usage or intermittent anesthesia on the patient is entirely doctor-dependent according to symptom severity.
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Intermittent anesthesia makes the patient communicate with the family, but continuous anesthesia only allows the family to meet but cannot communicate because the patient is asleep.
What Considerations to Be Noted Before the Usage of Anesthesia in Palliative Care?
In many cases, palliative care with anesthesia is required when other treatment fails to inhibit the symptoms. But before giving anesthesia, a few considerations regarding the patient's health are noted. It includes:
- All medical team members should collectively decide, before going for the anesthetic, whether or not they can manage the complications.
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If the patient is suffering from intolerable symptoms of pain, vomiting, difficulty in breathing, delirium, etc., make the physician go for an anesthetic.
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Written consent is essential before the administration of anesthesia. It is a kind of legal agreement doctors have if they are dealing with critical cases of patients, which says conditions can even lead to mortality during treatment—legal action for the doctor's safety from a patient casualty case. Even a consent agreement must state the situation of the patient. Using the anesthetic in such an illness can even lead to risks to the patient's life. The patient should be fully conscious while going through the agreement and should not be pressured to sign the consent. In an emergency, the patient's caregivers should sign the consent by fully acknowledging the severity of the patient's condition.
What Are the Anesthetics Used in Palliative Care?
There are many anesthetic agents used in palliative care. The most commonly used are:
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Opioids - These agents relieve pain by acting on the central nervous system and inducing drowsiness.
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Benzodiazepines - They also act on the brain's central nervous system to overcome anxiety and seizure symptoms. Midazolam is most often used in palliative care treatment because of its rapid onset and short duration of action. It is mainly used in delirium cases and difficulty breathing patients.
What Intraoperative Care Is Taken During Anesthesia Administration?
Anesthesia is primarily given in the hospital by the doctor. However, it can also be delivered in a home care environment. The doctor should prepare the initial dose very appropriately to manage the symptoms. It can be given intravenously or by any other means depending on the requirement, continuous or intermittent. The patient being treated is monitored every time. However, the patient's condition decides whether to monitor vital signs, if the patient is at end-of-life, only respiratory rate is seen, and near-to-end-of-life patient blood pressure and oxygen are measured. Fluids during this time are not usually advised as this can cause congestion, so little drinking is advised or given by feeding tubes to the patient.
Is Palliative Anesthesia Beneficial or Not?
Palliative anesthesia is used when the patient is near-to-end-of-life or at the end of life when nothing goes on to treat the patient's symptoms, making the condition severe to handle. Anesthesia during that period relieves the symptoms, and drowsiness makes the patient sleep a lot. The patient's case becomes painful due to decreased appetite. Few studies have shown that patients live for a week or more but hardly cross the month due to severity. So, palliative anesthesia has been shown to shorten the life of patients. However, it does benefit the patient by relieving him of the ongoing symptoms and lands him at risk of mortality.
Conclusion
Palliative care anesthesia is required when nothing goes on for withdrawal of the symptoms like difficulty in breathing and pain. In severely ill patients, the doctor uses palliative anesthesia to reduce the symptoms and relax the patient. The patient is given palliative anesthesia after informing and taking consent. However, it relieves the patient's signs but leads the patient to dangerous complications of mortality.
