Subcutaneous dexmedetomidine for baclofen withdrawal during palliative sedation

Sudden cessation of baclofen can produce a withdrawal syndrome even if it was previously orally administered. We present the case of a man who exhibited signs of baclofen withdrawal syndrome during palliative sedation. Attempts were made to induce muscle relaxation with ever-increasing doses of benzodiazepine. Ultimately, control over the withdrawal syndrome was regained by using a continuous subcutaneous infusion (CSCI) of dexmedetomidine, a highly selective α2 adrenergic agonist. Very limited published reports concerning CSCI of dexmedetomidine exist. To our knowledge, this is the first case to report its use as an adjunctive agent to treat baclofen withdrawal syndrome through the subcutaneous route in the palliative care setting.

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Tolerability of Continuous Subcutaneous Octreotide Used in Combination with Other Drugs

Journal of Palliative Care ◽

10.1177/082585979501100403 ◽

1995 ◽

Vol 11 (4) ◽

pp. 14-16 ◽

Cited By ~ 12

Author(s):

Sebastiano Mercadante

Keyword(s):

Care Setting ◽

Symptom Control ◽

Clinical Situation ◽

Oral Route ◽

Advanced Cancer Patients ◽

Good Tolerability ◽

Subcutaneous Infusion ◽

Palliative Care Setting ◽

Syringe Driver ◽

Drug Precipitation

Continuous subcutaneous infusion of octreotide combined with other drugs has proved to be useful in some circumstances in palliative care setting when the oral route is no longer available. Forty-four patients were administered octreotide alone or in combination with other drugs in the same syringe driver for symptom control in advanced cancer patients. Good tolerability and compatibility were observed without visual drug precipitation for a period of 48 hours at room temperature, the standard clinical situation in patients’ homes. Such a combination of drugs administered by the subcutaneous route makes possible the’ adequate control of symptoms in the final days of life.

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Subcutaneous magnesium in the advanced cancer setting

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2017-001360 ◽

2017 ◽

Vol 8 (2) ◽

pp. 191-193 ◽

Cited By ~ 2

Author(s):

Stephen J Fenning ◽

Steinunn R Boyce ◽

Paul Wilson ◽

Fran Stretton

Keyword(s):

Ovarian Cancer ◽

Hospital Admissions ◽

Subcutaneous Administration ◽

Advanced Ovarian Cancer ◽

Syringe Pump ◽

Subcutaneous Infusion ◽

First Case ◽

Continuous Subcutaneous Infusion ◽

Cancer Setting ◽

High Output

Hypomagnesaemia can arise from a variety of causes but is particularly prevalent in cancer populations. This case report describes a patient with recurrent symptomatic hypomagnesaemia, on the background of advanced ovarian cancer and a high-output ileostomy, who was successfully managed on a daily continuous subcutaneous infusion of magnesium via a syringe pump. There is limited published information on the subcutaneous administration of magnesium and, to our knowledge, this is the first case to report its routine delivery over 24 hours in a syringe pump. This novel but effective approach for administering magnesium can be delivered in the community and can, therefore, prevent repeated hospital admissions for patients with recurrent symptomatic hypomagnesaemia who would otherwise need intravenous replacement.

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P3384 Continuous subcutaneous infusion of treprostinil, a prostacyclin stable analogue, in primary pulmonary hypertension: 3 year experience

European Heart Journal ◽

10.1016/s0195-668x(03)96010-6 ◽

2003 ◽

Vol 24 (5) ◽

pp. 650

Author(s):

M RUIZ

Keyword(s):

Pulmonary Hypertension ◽

Primary Pulmonary Hypertension ◽

Subcutaneous Infusion ◽

Continuous Subcutaneous Infusion

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Anticoagulation by Constant Subcutaneous Heparin Infusion

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657112 ◽

1982 ◽

Vol 47 (01) ◽

pp. 001-002 ◽

Cited By ~ 3

Author(s):

Nenita Parrilla ◽

Jack Ansell

Keyword(s):

Clinical Trial ◽

Impedance Plethysmography ◽

High Dose ◽

Intravenous Therapy ◽

Heparin Dose ◽

Heparin Infusion ◽

Subcutaneous Infusion ◽

Subcutaneous Heparin ◽

Therapeutic Anticoagulation ◽

Continuous Subcutaneous Infusion

SummaryA preliminary clinical trial was conducted to determine the feasibility of achieving and regulating therapeutic anticoagulation with heparin given by continuous subcutaneous infusion. Five patients with deep venous thrombosis confirmed by impedance plethysmography and/or venography were studied. All patients received an initial heparin dose of 5000 units by IV bolus. This was followed by a continuous subcutaneous heparin infusion at a dose of 15 to 25 units per kilogram per hour. Effective levels of anticoagulation were achieved in all five patients. Regulation and maintenance of therapeutic anticoagulation were no more difficult than with intravenous therapy. No major complications were encountered during therapy.Continuous subcutaneous infusion of heparin may have advantages over standard intravenous therapy or high dose intermittent subcutaneous therapy. However, more extensive clinical evaluation is warranted.

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