A recently licensed opioid, Abstral^®, a rapid-acting sublingual tablet of fentanyl, is different from other opioids in its complicated usage. The points to consider are; a careful titration grounded on the assessment whether the increase of base or rescue is appropriate, setting up the tentative upper limit suitable for the baseline opioid, the differentiation of the concept between the rescue dose and the additional dose, instruction to the medical stuff as well as patients and family and cost benefit balance. Taking account of these points, we recommend introducing Abstral^® in our hospital to patients who have difficulty in swallowing or other gastrointestinal function only in the wards. The palliative care team, the department of pharmacy and the division of nursing collaborated to let the medical stuff know these concerns and introduced a license system in which only those doctors who receive an intensive course on the use of Abstral^® can prescribe it. At the same time, we gave a lecture for the nurses and other medical stuff repeatedly (ten times) so as to include as many as possible. A monitoring system of Abstral^® prescription is also established in our hospital.

Although continuous deep sedation (CDS) is sometimes used for terminally ill cancer patients to alleviate intolerable symptoms, there are few studies that comprehensively investigated CDS in general ward, including the rate of discussions by multiple occupations. The aim of this study was to retrospectively investigate the present state of CDS for patients in the general ward who were referred to the palliative care team (PCT). A total of 938 terminal cancer patients who were consulted with PCT between August 2012 and October 2015 were enrolled. Of the 938 patients enrolled in the study, 246 patients died in the general ward before the end of November 2015. Of the 246 patients, 28 patients (11.4%) were treated with CDS to alleviate intolerable symptoms in the terminal period. The mean duration of CDS was 4.1±3.1 days. Lung cancer was the most common in primary disease. The primary reason for starting CDS was dyspnea. All CDS were performed with midazolam. The discussions on CDS by multiple occupations were performed in all cases. We conclude that on weekdays the PCT visited the patient every day and was able to sedate all cases with sedation discussion by multiple occupations.