PURPOSE: 65% patients with lung cancer have dyspnea at some point of their illness & upto 95% with NSCLC have it near death. Reticence about the use of morphine for palliation of dyspnoea is common particularly where COPD co-exists & is compounded by the lack of availability of morphine in parts of developing countries. Ketamine produces excellent analgesia , produces bronchodilatation & does not produce respiratory or cardiovascular depression.
METHODS: We sought to evaluate the role of low-dose (0.2mg/kg) ketamine & midazolam (0.02mg/kg) in attenuation of terminal dyspnea. 16 patients with lung cancer & complaining of dyspnea admitted to the critical care unit(CCU). The subjective component of dyspnea was assessed using the Graphic Rating Scale(GRS) which has a value from 0 -10, 10 being maximum dyspnea. Each patient received low-dose ketamine & midazolam for relief of dyspnea. All patients received low-flow (2lit./min.) oxygen therapy via nasal cannulae. Immediately after admission all the patients were reassured & nursed in a decubitus of choice. GRS was recorded by an at the point of admission, ten minutes after starting oxygen therapy & ten minutes after administration of low dose ketamine & midazolam. All the haemodynamic monitoring were also recorded at these three points.
RESULTS: All patients enrolled had significant dyspnea at admission, as evident from the GRS scores of 8.250(SD 0.91), respiratory rate of 28.56(SD 5.0), mean arterial blood pressure of 102.7(SD 14.63), pulse rate of 115.62(SD 23.3) and SpO2 of 92.43(SD 2.38). All the patients benefited as evidenced by a statistically significant (p<0.01) improvement in all the monitored parameters.
CONCLUSION: Combination of low dose ketamine & midazolam can safely be used in the palliation of terminal dyspnea with excellent results. The duration of action of this combination in providing symptomatic relief was however short-lived, being 36.7 minutes on an average (SD 5.23), thus necessitating intermittent I/V top-ups. No adverse reports were obtained in our study.
CLINICAL IMPLICATIONS: Use of this combination is effective in palliation of terminal dyspnea.
DISCLOSURE: Abhijit Dam, No Financial Disclosure Information; No Product/Research Disclosure Information