96 PCN EOL Management Palliative Sedation

• Confirm that goal of care is comfort
• Advanced terminal illness
• Suffering severe refractory physical or neuropsychiatric symptoms – or – psychosocial problems
• Order to withhold life-sustaining interventions Informed consent
• Document all of above, inform clinical team

Specify loading dose, infusion, bolus doses

• Midazolam
  • 0.3-0.5 mg/kg over 2-5 minutes
  • Infusion 0.02-0.1 mg/kg/hr
  • Additional boluses = hourly infusion rate
• Propofol
  • (central venous catheter only)
  • Start infusion 2.5-5.0 mcg/kg/min (10-20 mg/hr)
  • Bolus doses 10-20 mg q 10 min
• Pentobarbital
  • Loading dose 2-3 mg/kg
  • Infusion 1-2 mg/kg/hr