Sedation palliative: experience in a palliative care unit of Montevideo

Introduction: palliative sedation is a therapeutic maneuver often used in patients at the end of life stage, and it constitutes a good medical practice when well applied. Objective: to analyze prevalence, medical indications and the sedation process at the Palliative Care Unit (UCP) of the Armed Forces Central Hospital in Montevideo, and to compare it with other international studies. Methods: this is a descriptive and retrospective study covering 274 patients who were treated consecutively at the UCP from December 1, 2006 through June 30, 2008. Results: average age was 65 years old. Causes for sedation were: delirium 35/58 (60.3%), pain 26/58 (44.8%), dyspnea 10/58 (17,2%), seizure 2/58 (3,4%), and vomits 1/58 (1.7%). Drugs used for sedation were: midazolam in 56/58 (96.5%) and haloperidol in 23/58 (39,6%). The interval between the initiation of sedation and death was 2.6 days. Consent was implicit, explicit or delegated in 100% of cases. Conclusions: palliative sedation is a therapeutic procedure for relieving refractory symptoms that may arise in dying patients at the end of life stage. The following conditions are required in order for it to be applied: refractory symptom, terminal illness and consent, and as long as possible, the decision must be supported by a second medical opinion. Palliative sedation is different from euthanasia, and the differences lie in the objective, the process and the result.