Pearls

Pearls Road Sign
  1. The primary intention of palliative sedation is to deliberately induce a temporary or permanent light-to-deep sleep, but not deliberately causing death, in patients with terminal illness and specific refractory symptoms.
  2. The intent of Palliative Sedation is the relief of intractable suffering caused by refractory symptom(s).
  3. The principle of double effect is a rule of conduct frequently used to determine when a person may lawfully and ethically perform an action from which two effects will follow, one bad, and the other good.
  4. A refractory symptom is one that cannot be adequately controlled despite aggressive efforts to identify a tolerable therapy that does not compromise consciousness.
  5. Pain, dyspnea, persistent emesis, and agitated delirium are the symptoms most commonly requiring sedation.
  6. Suffering from existential anguish can be just as significant and distressful as refractory physical symptoms, thus endorsing consideration of palliative sedation in refractory cases.
  7. Most patients requiring palliative sedation demonstrate more than one refractory symptom.
  8. Midazolam 0.5-5 mg bolus IV/SC, then CII/CSI at 0.5-1 mg/h; usual maintenance dose, 20-120 mg/d is the drug most commonly used for palliative sedation.
  9. The concept of respite sedation involves sedating a patient for a predetermined interval, such as 24-48 hours, then downwardly titrating the sedative dose until consciousness reappears.
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