Palliative sedation

Abstract

Palliative sedation is the controlled use of medications intended to induce and maintain the state of reduced consciousness. In this state, the patient does not suffer from symptoms that we can no longer control (refractory symptoms). The most frequent reasons for palliative sedation are uncontrollable terminal anxiety and difficulty breathing.
Midazolam is the medicine of choice for palliative sedation. The appropriate dose is determined by gradually increasing the initial dose until the desired effect – symptom control (titration) – is reached. The palliative sedation protocol sets out a clearly defined medical indication, the management and instructions for medical care as well as legal and ethical principles. Palliative sedation is not a synonym for euthanasia, nor does it shorten life.

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Povzetek

Paliativna sedacija je nadzorovana uporaba zdravil, ki povzročijo in ohranjajo stanje zmanjšane zavesti. V tem stanju bolnik ne trpi zaradi težav, ki jih ne moremo več obvladati (neobvladljiv simptom). Najpogostejša vzroka, da se odločimo za paliativno sedacijo, sta neobvladljiv terminalni nemir in težko dihanje.
Midazolam je zdravilo izbora za paliativno sedacijo. Ustrezno dozo določimo s postopnim višanjem doze zdravila do želenega učinka-obvladanje simptoma (titracija). Paliativna sedacija po protokolu predpisuje jasno opredeljeno medicinsko indikacijo, vodenje in napotke za zdravstveno nego ter pravna in etična načela. Paliativna sedacija ni sinonim za evtanazijo in ne skrajšuje življenja.