– 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