大多數接受安寧療護的末期病人都能經由安寧團隊人員的協助而緩解身、心、靈的不適。然而仍有少數的末期病人因難治的症狀（refractory symptom）需要使用緩和鎮靜（palliative sedation）療法。目前臨床上常用的緩和鎮靜藥物以苯二氮平為主，若合併有譫妄症狀則再加上抗精神病藥物。如果上述的藥物仍無法改善時，可以使用巴比妥酸鹽或麻醉誘導物來緩解病人的不適。本文敘述一位接受安寧療護的頭頸部癌症末期病人，因躁動使用midazolam及非典型抗精神病藥物無效後，使用異丙酚（propofol）來緩解病人難治症狀的經驗。文中亦探討使用propofol的過程中可能遭遇的副作用及倫理議題，並就臨床上健保給付的限制加以討論。

For the majority of the terminally ill patients undergoing hospice care, the discomfort from physical, emotional, and spiritual aspects is often alleviated by the palliative care team. However, a few of the terminally ill patients need to use palliative sedation for relief from refractory symptoms. Currently, the commonly used drugs for sedation in clinical practice are benzodiazepines. If the patient is diagnosed with delirium as well, antipsychotic drugs are administered as an add-on. If the symptoms of the terminally ill patients remain unresolved by the above medications, barbiturates or anaesthetic induction agents are administered to alleviate the suffering. This report describes the case of a terminally ill patient with head and neck cancer and agitated delirium who received palliative care and failed to respond to midazolam and atypical antipsychotics. In an attempt to alleviate the refractory symptoms, we administered propofol as a palliative sedative. We also monitored the possible adverse effects of propofol and considered the ethical aspect. In addition, some limitations with regard to propofol cover by the National Health Insurance were discussed.