1. Palliative sedation
Dr Peter Edmunds

2. Definition
"the intention to induce sleep in a patient with one or more refractory symptoms who is perceived to be close to death".

3. What it isn’t temporary use of complete sedation
management of symptoms by partial sedation
physician assisted suicide (PAS) or euthanasia
emergency sedation for crisis

4. When it is used
Refractory symptoms
Difficult symptoms

5. severe agitated delirium 60%
dyspnea and pain 20%

6. Criteria A terminal disease exists
The patient/client suffers from (a) refractory symptom(s)
death must be imminent (within days)
A DNR /NO CPR Order must be in effect.
Informed consent
Palliative Care physician consult and agreement must be obtained
It should be arranged and administered by an experienced palliative care team

7. Richmond Agitation Sedation Scale (RASS)
Target RASS +4
Combative, violent, danger to staff +3
Pulls or removes tube(s) or catheters; aggressive +2
Frequent non-purposeful movement, fights ventilator +1
Anxious, apprehensive , but not aggressive
Alert and calm -1
awakens to voice (eye opening/contact) >10 sec -2
light sedation, briefly awakens to voice (eye opening/contact) <10 sec -3
moderate sedation, movement or eye opening. No eye contact. -4
deep sedation, no response to voice, but movement or eye opening to physical stimulation -5
Unarousable, no response to voice or physical stimulation