Abstract：
Context: 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. Objectives: We aimed to describe efficacy and safety of palliative sedation in refractory sedation with propofol using a protocol based on low, incremental dosing. Methods: 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. Results: During the study period, 22 patients underwent sedation with propofol. Propofol was used successfully to control different refractory symptoms, mainly psychoexistential suffering and delirium. 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. Conclusion: 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.
摘要：
背景：丙泊酚是一种用于多种临床情况的全身麻醉药。尽管越来越多的证据支持它在姑息治疗中的应用，异丙酚很少用于姑息镇静。不愿采用异丙酚作为镇静剂通常与对不良事件如呼吸停止的恐惧有关。目的：我们旨在描述丙泊酚难治性镇静中姑息性镇静的疗效和安全性，增量给药。方法：一项回顾性观察性研究，根据新开发的方案，于2018年3月1日至2023年2月28日在马德里（西班牙）的姑息治疗病房接受丙泊酚镇静治疗的住院患者。结果：在研究期间，22例患者接受异丙酚镇静。丙泊酚成功地控制了不同的难治性症状，主要是心理存在的痛苦和谵妄。所有患者先前都曾尝试使用其他药物（咪达唑仑或lemoveprazine）进行镇静失败，并存在复杂镇静的危险因素。用Ramsay镇静量表测量的所有患者均达到令人满意的（深度）镇静水平，但是患者的总剂量差异很大。大多数患者（17，77％）接受异丙酚和其他镇静药物的联合治疗以发挥协同作用。异丙酚开始镇静和死亡之间的中位时间为26.0小时。没有记录到诱导期间呼吸暂停或死亡的病例。结论：丙泊酚姑息镇静方案基于低，增量给药，选择施用初始诱导丸剂，关于足够的镇静水平显示出优异的结果，没有观察到呼吸暂停或呼吸抑制。我们的结果促进了丙泊酚的使用，以达到姑息性镇静患者的难治性症状和危险因素在生命结束时复杂的镇静。
