Palliative sedation is a measure of last resort used at the end of life to relieve severe and refractory symptoms. It is performed by the administration of sedative medications in monitored settings and is aimed at inducing a state of decreased awareness or absent awareness (unconsciousness).
Palliative sedation (also called terminal and total sedation or continuous deep sedation) involves being medicated to reduce consciousness. Typically, the person remains unconscious until death. At the same time, all nutrition and fluids are stopped. Sedation may bring some relief for extreme pain and suffering.
Medications such as benzodiazepines, opiates, and antipsychotics are often used to alleviate patients' respiratory distress, agitation, and anxiety and cause sedation.
Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying.
Nor right to kill oneself through physician assisted suicide or to be killed through active euthanasia is recognized. But terminal sedation, though it does shorten the life of the patient, does not involve taking positive actions aimed at ending the patient's life.
Palliative sedation is the use of sedative medications to relieve refractory symptoms when all other interventions have failed. The phrase "terminal sedation" was initially used to describe the practice of sedation at end of life, but was changed due to ambiguity as to what the word 'terminal' meant.
Sedation does not make death come more quickly, but it can bring relief from distressing symptoms and allow a more peaceful death. It is important to discuss this with the patient, and their carer, family or friends, and address their concerns and worries.
In rare cases, however, patients may be woken up at some point, according to Downar. Perhaps a dying patient may be continuously sedated for a day or two to allow pain medication to work, says Downar, and then woken up in a day or two to see if the pain is still present.
Palliative sedation is the continuous administration of medication to relieve severe, intractable symptoms. Palliative sedation induces a coma-like state when symptoms such as pain, nausea, breathlessness, or delirium cannot be controlled while a patient is conscious. This state is maintained until death occurs.
Palliative sedation therapy
Terminally ill cancer patients near the end of life can experience refractory symptoms, which require palliative sedation. Midazolam is the most common benzodiazepine used for palliative sedation therapy.
Palliative sedation may be utilized in both adults and children [2-6] with advanced incurable (ie, terminal) illness in order to alleviate severe symptoms that are refractory to other forms of treatment. It is most commonly utilized for the treatment of refractory pain, dyspnea, agitated delirium, and convulsions.
Palliative sedation is offered when everything else has been tried to help the person dying of their illness be comfortable and all other options: ⦁⦁ Cannot help with the symptom. ⦁⦁ Have unacceptable side effects. ⦁⦁ Would take too long to work.
In 36% of the patients, palliative sedation was performed with morphine only. The estimated life shortening due to sedatives (including morphine) was 1 to 4 weeks in 21% and more than 1 month in 6%.
Although it can include end of life care, palliative care is much broader and can last for longer. Having palliative care doesn't necessarily mean that you're likely to die soon – some people have palliative care for years. End of life care offers treatment and support for people who are near the end of their life.
Results. The data of 2414 patients from 23 palliative care units were available for analysis. Five hundred two (21 %) patients received sedation in the last two weeks preceding their death, 356 (71 %) received continuous sedation until death, and 119 (24 %) received intermittent sedation.
Some patients need to be sedated for hours, days or even weeks. If they are doing well - waking up, are strong enough, and breathing by themselves - then the breathing tube can usually be taken out. Everyone is different so please ask the ICU nurse or doctor how long your loved one is likely to be sedated for.
The important findings, along with observations of long-time palliative care doctors and nurses, show: Brain activity supports that a dying patient most likely can hear. Even if awareness of sound cannot be communicated due to loss of motor responses, the value of verbal interactions is measurable and positive.
PST medications are given to relieve suffering by making a patient less aware. Criteria for palliative sedation therapy are different from MAiD in that PST is only an option when other comfort measures have not been effective and a person is in their last days of life.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
The sedation can also be reversed, so the person is not completely asleep during the dying process. Research has shown that palliative sedation does not shorten life. People die from their disease – not from sedatives.
Further, nurses provide information and compassionate care to both the patient and the family during the process of palliative sedation. Most nurses view palliative sedation as a positive and sometimes necessary last resort therapy to relieve refractory suffering of dying patients.
Palliative sedation should not be considered irreversible in all circumstances. It may be appropriate, in some clinical situations when symptoms are deemed temporary, to decrease sedation after a predetermined time to assess efficacy, continued symptoms and need for ongoing sedation.
Often patients who are about to die will shed a single tear, and in some instances a second tear.
Without sedation, pet euthanasia can be a very abrupt and confronting process. The final injection is fast acting. With sedation the transition from a conscious pet to passing is a gradual one. Using sedation means the process of saying good bye is much smoother, and peaceful.
In most cases, terminal agitation results from pain or changes in the body and mind. It is unlikely that your loved one's behavior genuinely reflects how they feel about you. As much as possible, try to respond to a loved one's terminal agitation with compassion.