The monitored use of medications intended to induce a state of decreased or absent awareness (unconsciousness) in order to relieve the burden of otherwise intractable suffering in a manner that is ethically acceptable to the patient, family, and health care providers.
Intermittent palliative sedation
Sedation to alter patient consciousness for prolonged periods, but also to provide some periods when the patient is alert.
Continuous palliative sedation
Sedation to continue to alter patient consciousness without specific plans to discontinue sedation.
Mild palliative sedation
Light and intermediate depth sedation to maintain consciousness so that patients can communicate with caregivers.
Deep palliative sedation
Sedation to achieve near or complete unconsciousness.
Sedation is used in palliative care in several settings:
- transient sedation for noxious procedures,
- sedation as part of burn care,
- sedation used in end-of-life weaning from ventilator support,
- sedation in the management of refractory symptoms at the end of life,
- emergency sedation,
- respite sedation, and
- sedation for psychological or existential suffering.
Drug selection
Psychotropic or sedative drugs are used to alter a patient’s psychological state in order to relieve their distress, although this frequently occurs at the expense of altering the consciousness level.
The drugs used in this situation can be classified as:
- anxiolytic sedatives, e.g., midazolam, lorazepam
- antipsychotics (neuroleptics), e.g., haloperidol, levomepromazine (North America: methotrimeprazine)
- sedative anti-epileptics, e.g., phenobarbital
- general anesthetics, e.g., propofol
