Sedação paliativa em oncologia pediátrica: relato de casos

Abstract

Introdution: The application of palliative care on children with terminal cancer faces several obstacles by reason of complex symptomatological management. Objectives: This case report aims to describe the experience of the Paediatric Cancer Center in HIAS (Hospital Infantil Albert Sabin) in cases that required palliative sedation, and the elaboration of protocol for indication, practice, and special care in sedation. Methods: We elaborated and applied a sedation algorithm to symptom management for palliative sedation in children age 2 to 17. The symptoms were categorized into visceral or psychiatric pathways. Best practice in sedation was addressed with prioritization of individual care, treatment variability, symptom relieve, and planned sedation to intended pain control. Results: Some individuals presented persistence of symptoms, although the use of benzodiazepines and opioids were satisfactory in most patients. The mean hospitalization time was extensive and the period between the beginning of palliative care and death was highly variable (2 to 15 days). Conclusions: Our algorithm was useful to establish an effective and safe measure to guide pediatric sedation and palliative care. The palliative care should be planned with qualified health professionals in the area to enhance its efficiency in relieving physical and physicological symptoms.