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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
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Last-resort options for palliative sedation.

Timothy E Quill1, Bernard Lo, Dan W Brock

  • 1Center for Ethics, Humanities and Palliative Care, University of Rochester Medical Center, Rochester, New York 14642, USA.

Annals of Internal Medicine
|September 17, 2009
PubMed
Summary
This summary is machine-generated.

Palliative sedation can alleviate end-of-life suffering when other treatments fail. This article clarifies proportionate palliative sedation (PPS) and palliative sedation with unconsciousness (PSU) to improve patient care.

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Area of Science:

  • Medical Ethics
  • Palliative Care
  • Clinical Practice

Background:

  • Some patients experience severe suffering despite advanced palliative care.
  • Access to palliative sedation is inconsistent due to misunderstandings about its types.
  • Refractory symptoms at the end of life necessitate further treatment options.

Observation:

  • Proportionate palliative sedation (PPS) uses minimal sedation for refractory symptoms, preserving consciousness when possible.
  • Palliative sedation with the intended end point of unconsciousness (PSU) is a less common, more controversial option.
  • Ethical consensus is stronger for PPS than for PSU.

Findings:

  • Clinical, ethical, and legal aspects of PPS and PSU require careful consideration.
  • Distinguishing between PPS and PSU is crucial for appropriate application.
  • Patient suffering can be refractory even with state-of-the-art palliative care.

Implications:

  • Palliative care and hospice programs need clear policies for PPS and PSU.
  • Training and competency assurance for clinicians are essential for safe sedation practices.
  • Addressing conscientious objection is vital for equitable access to end-of-life care.