Palliatieve sedatie

E.H. Verhagen, G.M. Hesselmann, T.C. Besse en A. de Graeff

Palliative sedation

– Palliative sedation is the intentional lowering of the level of consciousness of a patient in the last phase of life by means of the administration of sedatives.

– The objective of palliative sedation is to relieve severe physical or psychological suffering that is otherwise untreatable.

– Sedation is used in 12 of all patients dying in the Netherlands. Refractory delirium, dyspnoea or pain are the most common indications.

– If deep palliative sedation is used, the estimated life expectancy should be a few days to at most one week.

– Midazolam is used most often for continuous sedation, usually by subcutaneous infusion; if the response is insufficient, a combination of midazolam with levomepromazine or phenobarbital or monotreatment with propofol may be used.

– If continuous infusion is not desired or feasible, intermittent administration of midazolam, diazepam, lorazepam or chlorpromazine may be considered.

– Provided that it is used under the right circumstances, palliative sedation does not shorten life.

Ned Tijdschr Geneeskd 2005;149:458-61