• Stefaan Six, Steven Laureys, Jan Poelaert, Johan Bilsen, Peter Theuns, Liza Musch, and Reginald Deschepper.
• 1 Mental Health and Wellbeing Research Group, Department of Public Health, Vrije Universiteit Brussel, Jette, Belgium.
• Palliat Med. 2019 Jun 1; 33 (6): 712-716.

BackgroundAwareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question.Case PresentationA woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions.Case ManagementThe decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor).Case OutcomeThe patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise.ConclusionThis case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.

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