Sedación paliativa

Abstract

The palliative sedation is part of the overall treatment of a patient suffering a terminal illness. Palliative care has the aim to increase the comfort and functionality of the patient as long as possible. The word sedation comes from the Latin word sedare that means to calm, to ease. It is defined as the deliberate administration of drugs, required to reduce the conscience of a patient with advanced or terminal disease, as much as needed to adequately relieve one or more refractory symptoms with his explicit consent; direct or delegated. Sedation classified as primary, can be continuous or intermittent, superficial or deep. The palliative sedation is intended to lessen the consciousness and induce sleep. To sedate a terminal patient is a medical procedure that includes a careful assessment of symptoms, clearly establishing the goals of sedation and the drugs that used. In the case of critically ill patients, death is not a distant possibility considering their clinical condition, the terminal patient's death is a certainty, because their illness has also led to a "critical" situation. Informed consent can be obtained from patients or their relatives which must necessarily be based on the patient's medical history. Palliative care is not only difficult to achieve, and sometimes it is not sensible and harmful to use. The acquired verbal consent should be considered sufficient. The Royal Dutch Medical Association recommends the use of different medications considering midazolam as the first step, then levomepromazine coupled with midazolam; as third step phenobarbital and propophol under the supervision of an anesthesiologist.