{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T19:31:23Z","timestamp":1780515083349,"version":"3.54.1"},"reference-count":55,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Palliat Care"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delirium is a frequent and distressing complication in advanced cancer, often multifactorial and refractory to standard agents. Palliative sedation may be required when symptoms remain uncontrolled, and propofol is an emerging option in this context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We describe a 61-year-old woman with Stage IV lung adenocarcinoma admitted to a hospice-type palliative care (PC) unit. She had multiple comorbidities and a history of polysubstance use, including long-term methadone and benzodiazepines. On Day 7, she developed hyperactive delirium unresponsive to escalating neuroleptics, benzodiazepines, and barbiturates, consistent with \u201cpharmacoresistant\u201d delirium.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management\/Intervention<\/jats:title>\n                    <jats:p>After multidisciplinary review and discussion with her son, proportional PS was initiated using continuous intravenous propofol infusion. The infusion began at 60\u2005mg\/h (1.5\u2005mg\/kg\/h) and gradually titrated to 320\u2005mg\/h (\u22488\u2005mg\/kg\/h). Concurrently, transdermal fentanyl was increased to 300\u2005\u00b5g\/h for analgesia. Sedation depth was monitored with the \u201cConsciousness Scale for PC,\u201d with goals set at Levels 1\u20133 to allow intermittent interaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>Adequate sedation was achieved within 10\u2005min and maintained for 25 days until death, without respiratory or hemodynamic compromise. No adverse effects or signs of propofol infusion syndrome were observed, despite doses exceeding conventional thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the feasibility and safety of high-dose, long-term propofol infusion for refractory delirium in advanced cancer. While not routine, propofol may serve as a rescue agent when standard regimens fail, provided decisions are ethically grounded, monitoring is rigorous, and family involvement is prioritized.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08258597261436878","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T05:46:33Z","timestamp":1774849593000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["High-Dose Continuous Propofol for Refractory Hyperactive Delirium: A Case Report"],"prefix":"10.1177","author":[{"given":"Susana","family":"Marques-Martins","sequence":"first","affiliation":[{"name":"Santa Maria Local Health Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Miguel-Freitas","sequence":"additional","affiliation":[{"name":"University of Lisbon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e1tima","family":"Domingues-Oliveira","sequence":"additional","affiliation":[{"name":"Idanha Health Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4665-585X","authenticated-orcid":false,"given":"Paulo","family":"Reis-Pina","sequence":"additional","affiliation":[{"name":"Santa Maria Local Health Unit"},{"name":"University of Lisbon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,29]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association. 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