French legislation about sedation in palliative medicine evolved in 2016 with the introduction of a\nright to deep and continuous sedation, maintained until death. The objective was to describe midazolam sedation\nat the COL (Centre Oscar Lambret [Oscar Lambret Center], French regional center for cancer control), in order to\nestablish a current overview before the final legislative changes.\nMethods: Descriptive, retrospective and single-center study, concerning major patients in palliative care hospitalized\nfrom 01/01/2014 to 12/31/2015, who had been sedated by midazolam. The proven sedations (explicitly named) and\nthe probable sedations were distinguished.\nResults: A total of 54 sedations were identified (48 proven, 6 probable). Refractory symptoms accounted for 48.1% of\nindications, complications with immediate risk of death 46.3%, existential suffering 5.6%. Titration was performed in\n44.4% of cases. Sedation was continuous until death for 98.1% of the cases. Probable sedation had a higher failure rate\nthan proven sedation. Significant differences existed for the palliative care unit compared to other units regarding\ninformation to the patient, their consent, anticipation, mention by correspondence and carrying out titrations. When\npatients had already been treated with midazolam, the induction doses, initial maintenance doses, and doses at the\ntime of death were significantly higher. For those receiving opioids, the maintenance dose at the time of death was\nhigher. No comparison found a difference in overall survival.\nConclusions: After a sufficient follow-up has enabled teams to familiarize with this new legislation, reflection on\nsedation should be conducted to adapt to final recommendations.
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