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Sedation at the end of life 

Sedation at the end of life
Chapter:
Sedation at the end of life
Author(s):

Eric L. Krakauer

DOI:
10.1093/med/9780199656097.003.0182
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date: 07 May 2021

Palliative sedation is a well-accepted therapy that should be considered in the rare situations when a terminally ill patient whose overriding goal is comfort experiences severe suffering that is refractory to all available standard palliative interventions. Typically, such suffering is caused by physical or neuropsychiatric symptoms such as pain, dyspnoea, vomiting, seizures, agitated delirium, anxiety, or depression. The level of sedation should be proportional to an individual patient’s suffering and should be just deep enough to provide the desired relief. In some cases, sedation to unconsciousness is necessary. The intention of palliative sedation should be only to relieve suffering, never to hasten death. Informed consent must be obtained, and clinicians should demonstrate their intentions by documenting the regimen used and the patient’s response. Ideal medications have a rapid onset of action and a short duration of action that facilitate titration to the desired effect. The best agents are barbiturates such as pentobarbital and anaesthetic induction agents such as propofol.

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