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Dexmedetomidine for end of life sedation: retrospective cohort comparison study
  1. Benjamin Thomas1,2,
  2. Gregory Barclay1,2 and
  3. Michael Barbato3
  1. 1Palliative Medicine, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
  2. 2Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
  3. 3Palliative Care Unit, Port Kembla Hospital, Port Kembla, New South Wales, Australia
  1. Correspondence to Dr Benjamin Thomas, Palliative Medicine, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia; benjamin.thomas{at}


Objectives Infused sedatives are often utilised to alleviate distress at the end of life. Which sedative best achieves this is unknown. This study compares breakthrough medication requirements of patients treated with the novel agent dexmedetomidine compared with patients treated with standard-care sedatives.

Methods A retrospective cross-cohort comparison. Two studies of patients at the end of life under sedation at the same palliative care unit, one utilising novel sedatives, and the other standard care were compared. Breakthrough medication requirements were compared using paired t-tests, including opioids, benzodiazepines and anticholinergics. Changes in background infusions were compared.

Results The dexmedetomidine cohort required less breakthrough interventions per day compared with the standard care group, the reduction was significant (2.2 vs 3.9, p=0.003). There was a significant difference in benzodiazepine requirements, with the dexmedetomidine cohort requiring fewer doses per day than the standard care cohort (1.1 vs 0.6, p=0.03). Anticholinergics were more commonly utilised in the standard care cohort but there was no significant difference (p=0.22). Opioid requirements were similar across cohorts with comparable rates of breakthrough use and infusion increases.

Conclusions This study demonstrates a reduction in breakthrough medication requirements, particularly benzodiazepines, for patients sedated with dexmedetomidine at end of life.

  • end of life care
  • pharmacology
  • delirium
  • terminal care

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  • Contributors MB was the primary investigator for study 1, BT was the primary investigator for study 2, GB was a coinvestigator for both. MB and BT respectively extracted data from individual sets. BT performed the primary analysis and prepared the manuscript. GB and MB edited the manuscript. All authors had input into the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.