Does palliative sedation always relieve symptoms?

Palliative sedation is commonly used to treat refractory symptoms. A systematic review of guideline for palliative sedation suggested that mild sedation is preferred and the minimum amount of medication should be used. There is little objective evidence that sedation relieves symptoms because assessment of response is limited by the therapy. However, patient awareness during surgery occurs in 2%-3% of individuals of which the anesthesiologist is unaware. This results in a sense helplessness, acute fear, and panic. Awareness can occur in up to 17% of those undergoing conscious sedation. Seventeen percent of individuals who undergo palliative sedation fail to have symptoms relieved by sedation. Routine use of sedation scales should be used during palliative sedation to minimize treatment failure.