Propofol may be considered as a rescue option in selected refractory cases managed by experienced teams; however, given the low to very low certainty of available evidence, findings should be interpreted cautiously and supported by institutional protocols and further prospective research.
Abstract
Background
Palliative sedation is used to relieve refractory suffering in terminally ill patients. Propofol, an intravenous anesthetic, may offer advantages due to its rapid onset and short half-life.
Aim
To evaluate the role of propofol in palliative sedation, focusing on symptom control, sedation depth, survival time, safety, and ethical implications.
Design
Systematic review registered in PROSPERO (CRD42025643575; February 6, 2025).
DATA SOURCES
Scopus, MEDLINE, and Web of Science were searched for English-language studies (2005-2024) on propofol use in adult terminally ill patients. Studies comparing propofol with other sedatives or non-sedated controls were included; those involving anesthetic or intensive care settings were excluded. Risk of bias and certainty of evidence were assessed. Results were synthesized narratively.
Results
Ten non-randomized studies were included (observational, cross-sectional, cohort, case series, and before-and-after designs), mostly of moderate quality, conducted in Europe (n = 7) involving 4072 patients (28,3% received palliative sedation), mainly with cancer. Symptom control was reported in 73%-100% of cases, target sedation depth was achieved in 52%-100%, although outcome definitions and measurement methods varied. Survival ranged from 19 h to 38 days. Propofol was used alone (n = 4) or with other sedatives (n = 6). Respiratory depression was the main safety concern. Ethical issues included absence of explicit consent and rare reports of life-shortening intent.
Conclusions
Propofol may be considered as a rescue option in selected refractory cases managed by experienced teams; however, given the low to very low certainty of available evidence, findings should be interpreted cautiously and supported by institutional protocols and further prospective research.
Propofol was safely used to facilitate extubation and decreased baseline sedative exposure when used for sedation washout in a complex critically ill pediatric population and was tolerated by most patients at doses commonly exceeding guideline- recommended maximum rate and duration.
Benjamin Colwell, Ferras Bashqoy, Maria Spilios et al.· The Journal of Pediatric Pha...· 0 citations
BACKGROUND
Multimodal anesthesia (MMA) is widely used to reduce opioid use and improve postoperative recovery. However, evidence for bundled MMA regimens-defined as opioids plus ≥2 adjunct analgesic modalities-has not been systematically synthesized across patient-centered outcomes.
METHODS
We performed a systematic review and meta-analysis of randomized controlled trials comparing MMA (opioids plus ≥2 adjuncts, including regional techniques and/or systemic agents such as dexmedetomidine, ketamine, intravenous lidocaine, clonidine, or magnesium) with opioid-based general anesthesia in adults undergoing elective surgery. MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library were searched to 28 October 2025. Primary outcomes were postoperative pain, PONV, QoR-15, and pulmonary complications. Secondary outcomes included opioid consumption in Morphine Milligram Equivalent (MME) and PACU length of stay. Risk of bias was assessed with RoB 2 and certainty with GRADE. Registered in PROSPERO (CRD42024470056).
RESULTS
Twenty-one RCTs (n = 1828) were included. At 24 h, no clear effect of MMA on pain intensity was observed (10 trials, n = 785; MD -0.6, 95% CI -1.5 to 0.2; very low certainty). MMA reduced PONV incidence (4 trials, n = 352; RR 0.59, 95% CI 0.44 to 0.77; low certainty). For secondary outcomes, MMA reduced opioid consumption (10 trials, n = 915; MD -7.0 mg MME, 95% CI -12.8 to -1.3; moderate certainty), with the opioid-sparing effect persisting at 48 h (MD -14.0 mg MME) and study end (MD -16.0 mg). Data for QoR-15, PACU stay, and pulmonary complications were insufficient for pooling.
CONCLUSIONS
MMA shows no clear effect on postoperative pain at 24 h but reduces PONV incidence and opioid consumption. Evidence certainty ranges from moderate to very low. Larger, standardized trials are needed to define optimal MMA regimens and patient selection.
Stefano M Arigoni, Adina B Heitmann-Frei, Marc S. von Gernler et al.· Journal of clinical anesthes...· 0 citations
Intravenous sedation is optimal for profound anxiolysis in complex cases, while nitrous oxide is ideal for routine procedures, prioritizing rapid recovery and fewer side effects.
M. Nahar, Md Toufiqur Rahman, Mohammad Ataul Hasan et al.· Community Based Medical Jour...· 0 citations
Background Dexmedetomidine and propofol are the two most widely used non-benzodiazepine sedatives for mechanically ventilated ICU patients. Despite guideline recommendations for both agents, the optimal choice remains controversial owing to inconsistent evidence across patient subpopulations. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) directly comparing dexmedetomidine (DEX) with propofol (PROP) in adult ICU patients requiring mechanical ventilation. Databases searched included PubMed, Embase, Cochrane CENTRAL, and CNKI. Primary outcomes were duration of mechanical ventilation (MV) and ICU length of stay (LOS). Secondary outcomes included hospital LOS, all-cause mortality, delirium incidence, bradycardia, and hypotension. Random-effects models were applied using the restricted maximum likelihood (REML) estimator with Hartung–Knapp–Sidik–Jonkman (HKSJ) confidence interval correction. Risk of bias was evaluated using the Cochrane RoB 2.0 tool. Pre-specified subgroup analyses by ICU population type and sedation duration were performed. Results Fifteen RCTs (N = 1,603; DEX: n = 815, PROP: n = 788; published 2001–2021) were included in the primary analysis. Four additional studies were included in sensitivity analyses. Dexmedetomidine did not significantly reduce MV duration (MD = −0.58 h; 95% CI: −2.10 to 0.95; P = 0.419; I2 = 67.1%) or ICU LOS (MD = −0.19 days; 95% CI: −0.67 to 0.29; P = 0.388; I2 = 63.3%). No significant difference in hospital LOS (MD = −0.21 days; P = 0.284; I2 = 0%) or all-cause mortality (OR = 0.92; 95% CI: 0.76–1.12; P = 0.354; I2 = 0%) was observed. Among secondary outcomes, dexmedetomidine was associated with lower delirium incidence (OR = 0.52; 95% CI: 0.33–0.80; P = 0.010; I2 = 27.6%). Bradycardia trended higher with dexmedetomidine (OR = 2.40; 95% CI: 0.94–6.17; P = 0.062) without reaching significance. Subgroup analysis revealed that ICU population type significantly moderated MV duration heterogeneity (interaction P = 0.004). Sedation duration also significantly moderated MV results (interaction P < 0.0001). The delirium reduction was directionally consistent across all population subgroups (interaction P = 0.508). Conclusion In mechanically ventilated adult ICU patients, neither primary outcome (MV duration, ICU LOS) differed between dexmedetomidine and propofol. Dexmedetomidine may reduce ICU delirium incidence, but this secondary finding is borderline after correction for multiple comparisons and requires confirmation in dedicated trials. The higher bradycardia risk warrants vigilant haemodynamic monitoring during dexmedetomidine infusion. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261378906, identifier: CRD420261378906.
Xiaoyu Zhang, Song Qin, Meng-Jun Liu et al.· Frontiers in Neurology· 0 citations
Background Sedation is a cornerstone in the management of neurocritical care patients with brain injuries. However, optimal sedation practices remain controversial. This study aims to evaluate the association between initial sedation strategies and key clinical outcomes, including duration of mechanical ventilation, ICU length of stay, extubation success, and mortality. Methods This retrospective observational study analyzed 147 adult patients with acute brain injury admitted to neurocritical care units. Eligible patients received invasive mechanical ventilation (IMV) for ≥24 h and underwent at least one weaning attempt. Sedation agents assessed included propofol, midazolam, combined regimens, dexmedetomidine, sodium thiopental and no sedation. Data on demographics, comorbidities, ventilation parameters, and outcomes were extracted and analyzed using SPSS v27. Regression models evaluated the impact of sedation type on clinical outcomes. Results This study included 147 critically ill patients. Sedation practices shifted over time, with propofol use decreasing from 46.2% on Day 1 to 26.3% on Day 7, while the proportion of patients receiving no sedation increased to 38.7%. Hospital interventions, including use of ICP monitors and ventilation strategies, varied significantly across sedation groups. Combined sedation and no sedation groups had significantly prolonged mechanical ventilation and ICU stays. Regression analysis showed that compared to propofol, combined sedation was associated with increased IMV days (B = 3.470, p < 0.001), ICU stay (B = 5.501, p < 0.001), and delayed extubation (B = 5.662, p < 0.001). Midazolam and no-sedation groups showed variable associations across outcomes. These findings highlight the impact of sedation strategy on patient recovery and ICU resource utilization. Conclusion Sedation strategy significantly influences clinical aspects in neurocritical care. Propofol appears superior for facilitating faster recovery, while midazolam and combined use are linked to adverse outcomes. Individualized, protocol-driven sedation approaches are essential to optimize care for patients with acute brain injury.
Chunhao Zhou, Daxing Wu, Honghua Guo et al.· Frontiers in Medicine· 0 citations
Both agents are effective for short procedural sedation, whereas propofol ensures faster recovery, and Dexmedetomidine offers superior cardiorespiratory stability, whereas propofol ensures faster recovery.
Vikash Gaurav· International Journal of Pha...· 0 citations