Palliative Sedation

Question 1

Ordinary sedation

Answer 1

Goal: reduce suffering
No intent to decrease consciousness during usual waking hours. if consciousness reduced then need to change meds
Ex benzo for anxiety or insomnia

Question 2

Proportionate palliative sedation

Answer 2

Goal: Relieve suffering
Ok to have decreased level of consciousness if that is what it takes to relieve suffering
Unconsciousness not the goal but ok side effect if needed

Question 3

Palliative sedation to unconsciousness

Answer 3

Goal: Make pt unconscious because otherwise they have uncontrolled suffering
ex: unrelieved pain, dyspnea, nausea, delirium

Question 4

Respite sedation

Answer 4

Goal: temporary sedation while physicians work to start tx for symptoms causing suffering.
Eventually discontinue with hope that symptoms will be better controlled

Question 5

Midazolam

Answer 5

Loading dose: 0.2mg/kg
Repeat half loading dose every 30min
Once sedation achieved give 25% of total dose per hr as continuous SC infusion

Max: 10mg/hr
Not good if pt have chronic benzo use

Question 6

Lorazepam

Answer 6

0.5mg to 2mg PO/SL/buccal q1hr or SC q30min
OR 1-5mg IV bolus then continue infusion at 0.5-1/hr
Maintenance dose: 4mg/day to 40mg/day
Good for home care setting
Not good if pt have chronic benzo use

Question 7

Phenobarbital

Answer 7

Loading dose: 10mg/kg IM (repeat every 15min PRN)
Continuous infusion 10-20mg/hr

OR
Loading dose 200mg SC/IV then continuous 25mg/hr
Usual maintenance dose: 600-2,400mg/daily

Question 8

Thiopental

Answer 8

Loading dose: 5-7mg/kg
Continuous 20-80mg/hr IV

usual maintenance: 70-180mg/hr

Question 9

Propofol

Answer 9

Loading dose: 20-50mg IV (repeat every 10-15min PRN)
continue at 5-10mg/hr IV