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

Department of Anesthesiology, Pain Management Service, University of Southern California, Keck School of Medicine, Los Angeles, California

Angèle Ryan, MD

Department of Anesthesiology, Pain Management Service, University of Southern California, Keck School of Medicine, Los Angeles, California

Nalini Vadivelu, MD

Department of Anesthesiology, Pain Management Service, University of Southern California, Keck School of Medicine, Los Angeles, California

Pamela Merriam, RN, MSN, OCN

Department of Anesthesiology, Pain Management Service, University of Southern California, Keck School of Medicine, Los Angeles, California

Linda Rever, MD

Department of Anesthesiology, Pain Management Service, University of Southern California, Keck School of Medicine, Los Angeles, California

Patricia Harrison, MD

Department of Anesthesiology, Pain Management Service, University of Southern California, Keck School of Medicine, Los Angeles, California

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 (5g/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.

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