00:01
Another important
concept to consider,
especially for patients that
are near the end-of-life,
is something called
palliative sedation.
00:10
So this is when there are
one or more severe symptoms
that are just refractory to
standard palliative care.
00:16
So you've tried every
tool in your your toolkit
to try to help relieve that
person of their discomfort,
but they're still having
these severe symptoms.
00:28
In general, palliative sedation
should only be considered
for patients that
are close to death.
00:33
And this is really
in the the situation
where you're vigorously
trying to treat symptoms
with therapy known
to be efficacious.
00:41
So you're perhaps
bringing in consultants,
palliative care experts,
and trying to figure out
how to relieve the symptoms,
but they are intractable.
00:51
So you decide to
perform sedation.
00:55
So it should have
a therapy that is
dose dependent side
effect of sedation,
you foresee that,
you know, the the person
might become unconscious,
might be sedated from
these medications,
again, in order to relieve
their severe symptoms,
but its unintended
consequence in the sedation,
because really your main
aim the good consequence is
relieving their
intractable symptoms.
01:21
The level of sedation
that needs to be achieved
should be proportionate to the
patient's level of distress.
01:28
So if they are just
so uncomfortable,
so distressed by their symptoms,
you might need a further
level of sedation,
on knowing that that might mean
you know, their unconscious,
not really able to interact
with their environment.
01:46
And then if a person is
in palliative sedation,
obviously they can't, you
know, take in nutrition,
hydration,
and you're going to know that
at some point
they're going to die.
01:58
The expectation is that
it's really a death
from the underlying
disease process
that has been causing
these intractable symptoms.
02:05
There will certainly
be some amount
of dehydration or malnutrition,
because they've not been taking
any kind of nutrition
or hydration.
02:16
But the intent is
the sedation of the person
to relieve the symptoms.
02:23
There might be these other
intervening complications
that happen when
they're unconscious.
02:27
But again, your intent is
their pain and symptom relief.