Sedation by Propofol for Painful Care Procedures at the End of Life: A Pilot Study. PROPOPAL 1.

Abstract

At the end of life, patients may feel refractory pain during care procedures although they receive appropriate analgesia. They can benefit from a short-term sedation. Propofol is used for procedural sedation in emergency or reanimation departments. It may be adapted in a palliative care unit. The main objective was to verify whether propofol could allow us to administer care without causing major pain to patients with refractory pain at the end of life. We conducted an open, prospective, and uncontrolled pilot study. The study was conducted in one palliative care center in France. The subjects were patients with an estimated prognosis less than three months who experienced pain during care procedures, although they receive appropriate analgesia. Ten patients were included. Care was delivered with no major pain for 9 patients out of 10. The average duration of induction to reach deep sedation was 4 minutes (2-8) and of care procedures was 13 minutes (7-32). On average, the patient woke up 11.5 minutes after we stopped injecting propofol (7-18). Only one patient experienced a significant adverse effect caused by propofol, but it did not have any harmful consequence except the interruption of care procedures. Transitory sedation using propofol for terminally ill patients hospitalized in a palliative care unit can offer optimal comfort during painful care procedures without significant complications. Patients woke up quickly. Further studies will have to be conducted to verify these initial results and make sure there are no major drawbacks.