Rietjens et al1 compared the practices of palliative sedation and euthanasia in the Netherlands. Two conclusions deserve further attention. In 36% of the patients, palliative sedation was performed with morphine only. The estimated life shortening due to sedatives (including morphine) was 1 to 4 weeks in 21% and more than 1 month in 6%.
Palliative sedation is considered to be an effective treatment for dispelling refractory symptoms in patients near death. Benzodiazepines such as midazolam are proper sedatives for palliative care for patients with refractory symptoms such as delirium and terminal agitation. Palliation of pain or dyspnea first requires opioids. Although many palliative patients receive opioids prior to the initiation of palliative sedation, opioids are empirically not effective at producing sustained sedation.
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