Pediatric palliative sedation therapy with propofol: recommendations based on experience in children with terminal cancer.
BACKGROUND
The use of propofol for palliative sedation of children is not well documented.


OBJECTIVE
Here we describe our experience with the use of propofol palliative sedation therapy (PST) to alleviate intractable end-of-life suffering in three pediatric oncology patients, and propose an algorithm for the selection of such candidates for PST.


METHODS
We identified inpatients who had received propofol PST within 20 days of death at our institution between 2003 and 2010. Their medical records were reviewed for indicators of pain, suffering, and sedation from 48 hours before PST to the time of death. We also tabulated consumption of opioids and other symptom management medications, pain scores, and adverse events of propofol, and reviewed clinical notes for descriptors of suffering and/or palliation.


RESULTS
Three of 192 (1.6%) inpatients (aged 6-15 years) received propofol PST at the end of life. Consumption of opioids and other supportive medications decreased during PST in two cases. In the third case, pain scores remained high and sedation was the only effective comfort measure. Clinical notes suggested improved comfort and rest in all patients. Propofol infusions were continued until the time of death.


CONCLUSIONS
Our experience demonstrates that propofol PST is a useful palliative option for pediatric patients experiencing intractable suffering at the end of life. We describe an algorithm that can be used to identify such children who are candidates for PST.
Division of Anesthesiology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. doralina.anghelescu@stjude.org
Doralina L
DL
Anghelescu
Hunter
H
Hamilton
Lane G
LG
Faughnan
Liza-Marie
LM
Johnson
Justin N
JN
Baker
D000293:Adolescent; D002648:Child; D017809:Fatal Outcome; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008485:Medical Audit; D009369:Neoplasms / Q000150:complications*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods*; D015742:Propofol / Q000627:therapeutic use*; D019452:Terminally Ill
D006993:Hypnotics and Sedatives; D015742:Propofol