Propofol for palliative sedation: A systematic review of clinical outcomes, safety, and ethical implications.

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.