Midazolam en la sedación paliativa de pacientes con cáncer al final de la vida

Dunia Morales Morgado, Iván Ramón Concepción, Jorge Luis Soriano García, Mayté Lima Pérez, Noyde Batista Albuerne, Vilma Fleites Calvo, Masiel González Meisozo, Maritza González Blanco

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Introducción: La sedación paliativa (SP) permite el control de síntomas refractarios al final de la vida en pacientes con cáncer terminal.

Objetivo: Evaluar el uso de midazolam en pacientes con cáncer avanzado y síntomas refractarios.

Métodos: Se realizó un estudio retrospectivo y descriptivo de 141 pacientes en el Servicio de Oncología del Hospital "Hermanos Ameijeiras" (2007-2017). Criterios de inclusión: confirmación histológica de cáncer y síntomas refractarios en etapa terminal, edad ≥ 18 años, y expectativa de vida < 2 semanas. Se obtuvo el consentimiento informado. Las dosis, formas y vías de administración del midazolam fueron variables en dependencia de la severidad de los síntomas, experiencia del equipo médico, y preferencias de pacientes y/o familiares.

Resultados: Predominó el dolor con 31 pacientes (22 %), y el 42,5 % con dolor y delirio, como síntomas refractarios. El tiempo medio más corto para la sedación paliativa fue el delirio con 4,0 horas. La vía subcutánea fue la más empleada (46,8 %), y el 36,2 % de los pacientes tuvo un intervalo de hasta 24 horas de duración. La administración intravenosa continua permitió conseguir un tiempo medio para la sedación deseada más corto (6,6 horas). La sedación paliativa se realizó más frecuentemente en el hospital (73,0 %), que en la atención primaria.

Conclusiones: La sedación paliativa con midazolam tiene impacto en el control de los síntomas refractarios al final de la vida en pacientes con cáncer avanzado.

Palabras clave: sedación paliativa; síntoma refractario; cuidados paliativos; midazolam.

Referencias

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