Palliative Care Unit, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
Health Research Institute of the Jimenez Diaz Foundation, Madrid, Spain.
J Palliat Med. 2024 Oct;27(10):1339-1345. doi: 10.1089/jpm.2023.0672. Epub 2024 Jul 8.
Propofol is a general anesthetic used in multiple clinical scenarios. Despite growing evidence supporting its use in palliative care, propofol is rarely used in palliative sedation. Reluctance toward the adoption of propofol as a sedative agent is often associated with fear of adverse events such as respiratory arrest. We aimed to describe efficacy and safety of palliative sedation in refractory sedation with propofol using a protocol based on low, incremental dosing. A retrospective observational study featuring inpatients receiving sedative treatment with propofol in our palliative care unit in Madrid (Spain) between March 1, 2018 and February 28, 2023, following a newly developed protocol. During the study period, 22 patients underwent sedation with propofol. Propofol was used successfully to control different refractory symptoms, mainly psychoexistential suffering and . All patients had undergone previous failed attempts at sedation with other medications (midazolam or lemovepromazine) and presented risk factors for complicated sedation. All patients achieved satisfactory (profound) levels of sedation measured with the Ramsay Sedation Scale, but total doses varied greatly between patients. Most patients (17, 77%) received combined therapy with propofol and other sedative medications to harness synergies. The median time between start of sedation with propofol and death was 26.0 hours. No cases of apnea or death during induction were recorded. A protocol for palliative sedation with propofol based on low, incremental dosing, with the option of administering an initial induction bolus, shows excellent results regarding adequate levels of sedation, without observing apnea or respiratory depression. Our results promote the use of propofol to achieve palliative sedation in patients with refractory symptoms and risk factors for complicated sedation at the end of life.
异丙酚是一种在多种临床情况下使用的全身麻醉剂。尽管越来越多的证据支持将其用于姑息治疗，但异丙酚在姑息镇静治疗中很少使用。人们对将异丙酚作为镇静剂采用的抵触通常与对呼吸停止等不良事件的恐惧有关。我们旨在描述使用基于低剂量递增的方案的异丙酚姑息镇静治疗难治性镇静的疗效和安全性。
这是一项回顾性观察研究，纳入了 2018 年 3 月 1 日至 2023 年 2 月 28 日期间在马德里（西班牙）姑息治疗病房接受异丙酚镇静治疗的住院患者。在研究期间，有 22 名患者接受了异丙酚镇静。异丙酚成功地用于控制不同的难治性症状，主要是心理存在痛苦和 。所有患者均在前一次使用其他药物（咪达唑仑或左美丙嗪）镇静治疗失败且存在镇静治疗并发症风险因素的情况下接受了治疗。所有患者均达到了满意（深度）的镇静水平，通过 Ramsay 镇静评分测量，但患者之间的总剂量差异很大。大多数患者（17 例，77%）接受了异丙酚联合其他镇静药物的联合治疗，以发挥协同作用。从开始使用异丙酚镇静到死亡的中位数时间为 26.0 小时。在诱导过程中没有记录到呼吸暂停或死亡的情况。
基于低剂量递增、可给予初始诱导剂量的异丙酚姑息镇静方案显示出良好的结果，可达到适当的镇静水平，而不会出现呼吸暂停或呼吸抑制。我们的结果促进了在难治性症状和临终时镇静治疗并发症风险因素的患者中使用异丙酚来实现姑息镇静。
