Y47.9 + (Z51.5)
Sedation in palliative care has unique objectives, and tolerance for some adverse effects may be greater than in other situations. There is also an emphasis on avoiding parenteral medication. Palliative sedation should be undertaken by clinicians experienced in the process and the advice of an expert should be sought where necessary. Sedation should only be started after discussion with, and with the consent of, the patient and/or family (when the patient is unable to consent).
The aim of sedation in palliative care is to ameliorate refractory suffering and not to hasten death.
Palliative care medication addresses symptoms such as pain, dyspnoea, nausea and depression. Managing many of these symptoms involves the use of medications which may have sedative properties. Palliative sedation involves the additional use of medication where sedation is the primary objective, and is appropriate only after standard care has proven unsuccessful.
GENERAL MEASURES
Pain must always be the first symptom to be excluded.
Always look for reversible causes of symptoms prior to prescribing sedation such as dehydration, hypoxia, concurrent synergistic sedative medicines, hypercalcaemia, renal failure, or infection.
Caution should be exercised and palliative care prescription examined for possible drug-drug interactions, prior to commencing sedation (or escalating doses of sedative medicines).
Dose escalation may be considered only if there is evidence of inadequate sedation.
MEDICINE TREATMENT
Dosing in frail, elderly patients should be titrated to effect.
- Lorazepam, oral, 0.5 mg 4 hourly.
- Tablets may be crushed and administered sublingually.
OR
- Haloperidol, oral, 0.75 mg 4 hourly.
Patient unable to take oral medication or terminal sedation required:
- Midazolam, SC/IV:
- Initial dose: 1–5 mg as needed
- Titrate to effect.