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在宅医療でのブロマゼパム坐剤(セニラン®坐剤)の意味(セデーション) | いなかの薬剤師 " /> 動画 在宅医療 高齢者
在宅医療におけるブロマゼパム坐剤(セニラン®坐剤)の意味~身の置き所がない時、セデーションなど~
薬剤師も患者の自宅に訪問する在宅医療に関わる機会が増えている。
人生の最終段階を病院ではなく自宅で迎える人が増えているので自然なことである。がん、ALS、寝たきり・・・病態は様々。
そんな中、「セニラン®坐剤」の処方・・・個人的にちょっとドキっとする。
そんな「セニラン®坐剤」についてざっくりとまとめる。
セデーションと安楽死の違いもちょっと載せている。
①効能・効果
添付文書上
「麻酔前投薬」
「通常、成人にはブロマゼパムとして 1 回 3 mgを術前夜又は 麻酔前に直腸内投与する」
・・・これしかない。
ただ、鎮静目的で使われる。
ダイアップ®よりは弱い鎮静作用である。
もともと先発であるレキソタン®錠の坐薬と覚えるとイメージしやすい
3mg坐剤は錠剤でいうと何mgと同じくらい?
健康成人に 3mg 坐剤を投与した場合,投与後約 3 時間で最高血中濃度に達し,5mg 錠剤とほぼ同等の生物学的利用率を示すことが報告されている。
在宅における使い方
「ターミナルセデーション」に「セニラン坐剤®」を使う。
亡くなる数日前に用いることがある。
穏やかに最期を迎えるために用いるのだ。
だから、在宅で関わっている患者に出ると少しドキドキしてしまう。
坐薬なので経口摂取が出来ない患者にも使いやすいのがポイントである。
処方せん上の記載は?
「身の置き所のないとき」
他には、「不眠時」「不穏時」など
量は、1個だったり半分(分割使用)だったりする。
※老々介護のこともあるので坐剤の分割のやり方はしっかり説明しておく
必要がある。
いざという時、慌てると上手く使えないかもしれないので・・・
下記に動画としても載せておく。
②セデーションとは?
鎮静は、医療用語でいうと「セデーション」である。
終末期の苦痛緩和を目的とした場合を「ターミナルセデーション」という。
※最近は、「終末期」のことを「人生の最終段階」と言ったりする。
定義は?
意識レベルを低下させることで苦痛を緩和する行為
※色々な場面で・・・
緩和医療、人工呼吸器を使うとき、手術のときなど
家族への対応
セデーションによって寿命(残された時間)が短くなることはないと
説明することが大切。
安楽死との違いもざっくりと
安楽死は、「死期を早める」「死へつながる薬物投与」「結果として死を迎えること」が違う。
セデーションは、あくまでも「鎮静」が目的なので死期も早めないし、
それによって死を迎えることもない。直接的にセデーションが関係しない。
参考資料
セニラン®坐剤、添付文書、インタビューフォーム
笠間俊男,日浦 満,中井美枝子,他 : 健康人における Bromazepam 坐薬の生体内動態.基礎と臨床 1983 ; 17 : 1049-1055(Ⅰ)