Muscle spasm. Parenteral benzodiazepines, such as midazolam, can be used to relieve muscle spasm and spasticity in the last days of life (Table 3).
Agitation / delirium
Intermittent anxiety / distress – midazolam SC 2mg, repeated at hourly intervals as needed. If ≥3 doses are required within 4 hours with little or no benefit, seek urgent advice or review. If >6 doses are required in 24 hours, seek advice or review.
The use of special drugs called sedatives to relieve extreme suffering by making a patient calm, unaware, or unconscious. This may be done for patients who have symptoms that cannot be controlled with other treatment.
Morphine is sometimes used when a person is in the advanced stages of illness, and his or her overall condition is declining. If the person is experiencing moderate to severe pain or shortness of breath, his or her doctor will often prescribe morphine.
Medicine for pain in palliative care – an appropriate opioid, for example, morphine, diamorphine, oxycodone or alfentanil. Medicine for breathlessness – midazolam or an opioid. Medicine for anxiety – midazolam. Medicine for delirium or agitation – haloperidol, levomepromazine, midazolam or phenobarbital.
How Long Does the Active Stage of Dying Last? The active stage of dying generally only lasts for about 3 days. The active stage is preceded by an approximately 3-week period of the pre-active dying stage.
Pulse and heartbeat are irregular or hard to feel or hear. Body temperature drops. Skin on their knees, feet, and hands turns a mottled bluish-purple (often in the last 24 hours) Breathing is interrupted by gasping and slows until it stops entirely.
Midazolam injection is used to produce sleepiness or drowsiness and relieve anxiety before surgery or certain procedures.
In fact, most people who undergo continuous palliative sedation have already stopped eating, in most cases because people near death tend to lose their appetite “as part of the dying process,” Goldman explains. Studies support the theory that CPST doesn't shorten lives when used appropriately.
Not Euthanasia
In both cases, the goal is to relieve suffering. But many doctors who use palliative sedation say the bright line that distinguishes palliative sedation from euthanasia, including aid-in-dying, is intent.
Palliative sedation (also called terminal and total sedation or continuous deep sedation) involves being medicated to reduce consciousness. Typically, the person remains unconscious until death. At the same time, all nutrition and fluids are stopped. Sedation may bring some relief for extreme pain and suffering.
Palliative sedation is a measure of last resort used at the end of life to relieve severe and refractory symptoms. It is performed by the administration of sedative medications in monitored settings and is aimed at inducing a state of decreased awareness or absent awareness (unconsciousness).
Midazolam has an elimination half-life of 1.5–3 h. The duration of action is 60–120 min.
Dying patients unable to take oral medication
Buccal midazolam is another option and can be acceptable for patients. †Midazolam 20mg to 30mg via continuous subcutaneous infusion (CSCI) over 24 hours can be used as maintenance therapy.
Midazolam is characterized as a short-acting benzodiazepine. The half-life, which is how long it takes for half the drug to leave the system, is 1.5 to 2.5 hours. This is actually very short compared to many other benzodiazepines.
Midazolam may cause some people to feel drowsy, tired, or weak for 1 or 2 days after it has been given. It may also cause problems with coordination and one's ability to think.
Midazolam will make you feel relaxed and drowsy. It will also give you amnesia. So, even if you're awake during your procedure, you won't remember what happened after the medication wears off.
Visions and Hallucinations
Visual or auditory hallucinations are often part of the dying experience. The appearance of family members or loved ones who have died is common. These visions are considered normal. The dying may turn their focus to “another world” and talk to people or see things that others do not see.
They Know They're Dying
Dying is a natural process that the body has to work at. Just as a woman in labor knows a baby is coming, a dying person may instinctively know death is near. Even if your loved one doesn't discuss their death, they most likely know it is coming.
What Happens One Hour After Death? At the moment of death, all of the muscles in the body relax, a state called primary flaccidity . 3 Eyelids lose their tension, the pupils dilate, the jaw might fall open, and the body's joints and limbs are flexible.
Caregivers, family, and healthcare providers should always act as if the dying person is aware of what is going on and is able to hear and understand voices. Hearing is one of the last senses to lapse before death.
The patient's bowel movements may stop entirely, or they may become incontinent. Their breathing may become shallow and irregular, with long pauses that grow frequent as death approaches. There may also be sounds of chest congestion and throat rattling in the last hours.
As circulation slows, the arms and legs become cool and may be bluish in color. The underside of the body may darken and a pulse may be difficult or impossible to find. Loss of control of bladder and bowel functions may occur around the time of death.