Ketamine-fentanyl-midazolam infusion for the control of symptoms in terminal life care

• Published in: American journal of hospice & palliative medicine Vol. 17; no. 2; pp. 127 - 134
• Main Authors: Berger, Jack M., Ryan, Angèle, Vadivelu, Nalini, Merriam, Pamela, Rever, Linda, Harrison, Patricia
• Format: Journal Article
• Language: English
• Published: Thousand Oaks, CA Sage Publications 01-03-2000
• Subjects: Aged; Aged, 80 and over; Analgesics - pharmacology; Analgesics - therapeutic use; Cognition Disorders - drug therapy; Cognition Disorders - etiology; Drug Therapy, Combination; Female; Fentanyl - pharmacology; Fentanyl - therapeutic use; Humans; Hypnotics and Sedatives - pharmacology; Hypnotics and Sedatives - therapeutic use; Infusions, Intravenous; Ketamine - pharmacology; Ketamine - therapeutic use; Male; Midazolam - pharmacology; Midazolam - therapeutic use; Middle Aged; Neoplasms - complications; Nursing; Pain - diagnosis; Pain - drug therapy; Pain - etiology; Pain Measurement; Psychomotor Agitation - drug therapy; Psychomotor Agitation - etiology; Receptors, N-Methyl-D-Aspartate - antagonists & inhibitors; Retrospective Studies; Terminal Care - methods; Treatment Outcome
• ISSN: 1049-9091; 1938-2715
• DOI: 10.1177/104990910001700213

In this report, we describe nine terminally ill patients with metastatic cancer who were treated with an intravenous infusion consisting of ketamine (2 mg/ml)/fentanyl (5αg/ml)/midazolam (0.1 mg/ml) (K/F/M) to control pain after traditional analgesic therapies were unsuccessful. In addition to pain, all patients exhibited some symptoms of cognitive compromise and agitation. After initiation of the K/F/M infusion, all patients exhibited some degree of qualitative improvement in these symptoms as well as in overall pain control. We feel that these observations warrant reporting of the efficacy of this infusion for the treatment of uncontrolled pain and agitation in terminally ill patients when the traditional methods of pain control are inadequate.