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Palliative sedation

Author
Nathan Cherny, MD
Section Editor
Robert M Arnold, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

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). The intent of palliative sedation is to relieve the burden of otherwise intolerable suffering for terminally ill patients and to do so in such a manner so as to preserve the moral sensibilities of the patient, medical professionals involved in his or her care, and concerned family and friends [1].

This topic will review the indications and administration of palliative sedation in patients nearing the end of life, as well as special applications of palliative sedation in other palliative care settings, such as in emergency situations, for respite, and for psychological distress. Other aspects of symptom care in the palliative setting are covered separately. (See "Overview of managing common non-pain symptoms in palliative care".)

INDICATIONS

Palliative sedation may be utilized in both adults and children [2-6] with advanced incurable (ie, terminal) illness in order to alleviate severe symptoms that are refractory to other forms of treatment. It is most commonly utilized for the treatment of refractory pain, dyspnea, agitated delirium, and convulsions. However, there is much variability in the use definition of “refractory” symptoms, and thus, in the prevalence of use of palliative sedation (table 1) [7].

Some emergency situations for which palliative sedation could be considered may include massive hemorrhage, asphyxiation, an overwhelming pain crisis, and severe terminal dyspnea [8-10]. (See 'Emergency sedation' below.)

Still, other than in emergency situations, intermittent or mild sedation should generally be attempted before palliative sedation. For some patients, a state of "conscious sedation", in which the ability to respond to verbal stimuli is retained, may provide adequate relief without total loss of interactive function.

                        

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Literature review current through: Nov 2016. | This topic last updated: Wed Jun 01 00:00:00 GMT+00:00 2016.
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