Palliative Sedation

End of Life Online Curriculum - Modules

Overview of Palliative Care	Dyspnea	Home Hospice
Opioid Conversion	Prognostication	Transition to Death
Palliative Sedation	Communication	Bereavement

Palliative Sedation

Introduction & Learning Objectives

Definition and Epidemiology

Ethical Framework: The Principle of Double Effect

Definition of Refractory Symptoms

The Problem of Psychological Suffering

Clinical and Pharmacological Guidelines

Respite Sedation

Medications of Choice

Appendices

Ramsay Sedation Scale

Interoperative Sedation Scale

Richmond Agitation Sedation Scale

Ramsay Sedation Scale

1	Patient is anxious and agitated or restless, or both
2	Patient is co-operative, oriented, and tranquil
3	Patient responds to commands only
4	Patient exhibits brisk response to light glabellar tap or loud auditory stimulus
5	Patient exhibits a sluggish response to light glabellar tap or loud auditory stimulus
6	Patient exhibits no response
Source: Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxolone-alphadalone. BMJ. 1974;2:656-659. PubMed

See also:

Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Am J Health Syst Pharm 2002 Jan 15;59(2):150-78.

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©End of Life Curriculum Project, a joint project of the US Veterans Administration and SUMMIT, Stanford University Medical School.
Funded by a grant to the Veterans Administration Nationwide Palliative Care Network by the National Library of Medicine. VJ Periyakoil, MD, Director.