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    Palliative Sedation

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    Diklatpimempat Angkatanlimabelas
    The document outlines an 11-step approach to palliative sedation, beginning with early discussions with the patient about their end-of-life wishes. Key steps include ensuring palliative sedation is necessary and appropriate, documenting the decision-making process, making arrangements for medication administration and caregiver availability, and evaluating and adjusting the patient's level of sedation based on their comfort. The goal of palliative sedation is to relieve refractory symptoms for patients with less than 1-2 weeks to live.

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    Palliative Sedation

    Uploaded by

    Diklatpimempat Angkatanlimabelas
    23 views4 pages
    The document outlines an 11-step approach to palliative sedation, beginning with early discussions with the patient about their end-of-life wishes. Key steps include ensuring palliative sedation is necessary and appropriate, documenting the decision-making process, making arrangements for medication administration and caregiver availability, and evaluating and adjusting the patient's level of sedation based on their comfort. The goal of palliative sedation is to relieve refractory symptoms for patients with less than 1-2 weeks to live.

    Original Description:

    PALLIATIVE SEDATION Palliative sedation Landelijke richtlijn, Versie: 2.0

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    The document outlines an 11-step approach to palliative sedation, beginning with early discussions with the patient about their end-of-life wishes. Key steps include ensuring palliative sedation is necessary and appropriate, documenting the decision-making process, making arrangements for medication administration and caregiver availability, and evaluating and adjusting the patient's level of sedation based on their comfort. The goal of palliative sedation is to relieve refractory symptoms for patients with less than 1-2 weeks to live.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    23 views4 pages

    Palliative Sedation

    Uploaded by

    Diklatpimempat Angkatanlimabelas
    The document outlines an 11-step approach to palliative sedation, beginning with early discussions with the patient about their end-of-life wishes. Key steps include ensuring palliative sedation is necessary and appropriate, documenting the decision-making process, making arrangements for medication administration and caregiver availability, and evaluating and adjusting the patient's level of sedation based on their comfort. The goal of palliative sedation is to relieve refractory symptoms for patients with less than 1-2 weeks to live.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    PALLIATIVE SEDATION

    Stepwise approach
    Decision-making
    1. At an early stage (where possible), discuss the wishes of the
    patient with regard to palliative sedation in the last stages of
    life and provide information about its possibilities and
    restrictions.
    2. If palliative sedation is being considered, check whether all
    indications and conditions are met:
    • the presence of one or more refractory symptom(s)
    • expertise and consensus of the team; if deemed
    necessary, consultation of an external expert (e.g., a
    palliative care team)
    • sedation in line with the wishes of the patient and/or his
    family; make a clear distinction between a request for
    sedation and a request for euthanasia
    • life expectancy < 1-2 weeks (only in the case of deep
    and continuous sedation)
    3. Document the process of decision-making in the medical file
    and inform all caregivers involved.

    1
    Management
    1. Make agreements regarding the desired duration of sedation
    (continuous or temporary/intermittent) and about
    evaluation of its effect; document this clearly in the medical
    file and inform all caregivers involved.
    2. Make clear arrangements regarding the availability and
    attainableness of all professional caregivers and explain to
    the family how they can be contacted.
    3. Consult, if necessary, with a palliative care team regarding
    execution of the procedure.
    4. In principle, use subcutaneous or intravenous administration
    of sedatives according to the following schedule:
    • Step 1: 10 mg bolus midazolam s.c., followed by 1.5 -
    2.5 mg/hr s.c./i.v.; if the effect is insufficient, increase
    the dose by 50% every 4 hours (always in combination
    with a 5 mg bolus); use a lower starting dose and longer
    interval if risk factors are present. At each dosage level,
    an extra bolus of 5 mg s.c. may be administered every 2
    hours if the effect is insufficient. At doses >20 mg/hr go
    to step 2.
    • Step 2: Levomepromazine 25 mg bolus (if required,
    another bolus of 50 mg after 2 hours), followed by 0.5 -
    8 mg/hr in combination with midazolam; if midazolam
    and levomepromazine have insufficient effect, cease
    both drugs and go to step 3.
    2
    • Step 3: Propofol 20 - 50 mg bolus i.v., followed by
    20mg/hr i.v.; if the effect is insufficient, increase every
    15 minutes by 10 mg/hr (drug administration under
    supervision of an anaesthesiologist).
    5. In case of a short estimated life expectancy (<24-48 hours),
    use intermittent administration of sedatives:
    • midazolam 6 dd 5-10 mg; if necessary, increase the dose
    by 50% every 4 hours; an extra bolus may be
    administered between administrations, if required.
    • diazepam 10 mg rectally every hour until adequate
    sedation is attained
    • lorazepam sublingually 1-4 mg every 4 hours
    • clonazepam sublingually 1-2,5 mg every 6 hours
    6. Discontinue all unnecessary medication; continue
    administration of morphine only to treat pain and/or
    dyspnoea and adjust the dose to the (presumed) degree of
    pain and/or dyspnoea; continue haloperidol in the case of
    refractory delirium.
    7. Take additional measures if necessary (urinary catheter,
    prevention of bed sores, oral care, enema etc.).
    8. Discontinue artificial nutrition and fluids in case of
    continuous and deep sedation; consider superficial or
    intermittent sedation if discontinuation or not starting fluids
    is unwanted.

    3
    9. Evaluate the effect every 1-2 hours until a stable situation
    has been achieved and thereafter at least once every 24
    hours; titrate the dose according to the level of (dis)comfort
    of the patient (proportionality). Adjust the dose of sedatives
    where required.
    10. Document the course of sedation in the medical file.
    11. Pay attention to the load capacity of the informal and
    professional care providers involved.

    Source:
    Palliative sedation
    Landelijke richtlijn, Versie: 2.0

    Uploade by: IKA SYAMSUL HUDA MZ

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