When Midazolam Fails and the Professional Twitches: Propofol for Palliative Sedation

Abstract

Delirium with refractory agitation is a common indication for palliative sedation. Significant distress and suffering can be experienced by patients, relatives and caregivers when conventional palliative sedation strategies fail in end-of-life situations. We present a case report of a cancer patient where the use of propofol in the treatment of hyperactive delirium with agitation refractory to palliative sedation with midazolam was rapidly effective, illustrating the relevance of managing the suffering created by this challenging clinical scenario in the palliative care setting. Despite the fact that suboptimal results in palliative sedation are not infrequent, medications such as propofol are rarely used. Thus, the case exposed aims at helping other healthcare professionals handle the difficult situation that arises when conventional sedation fails, generating much suffering in all the parties involved, by proposing the use and titration of propofol by skilled professionals.