[Propofol: the ideal long-term sedative?]

Propofol is commercially available as Disoprivan. It is formulated as an aqueous emulsion with 1% 2,6-diisopropylphenol, 10% soya bean oil, 2,5% glycerol and 1.2% egg phosphatide. Since 1986, propofol has been used as a sedative drug in the ICU and is highly valued for its numerous positive qualities. High effectiveness is combined with excellent control, which is demonstrably still present even after 2 weeks of sedation. This control enables short-term neurological surveillance of the patient and rapid weaning from the respirator once drug administration is stopped. Propofol does not disturb cerebral autoregulation. Depression of spontaneous breathing facilitates the ventilation of intubated patients. As the solution contains lipids, it contributes to parenteral nutrition. All in all, ease of control and rapid response make propofol a highly valued product in ICUs. It is easy to understand why many ICU specialists consider propofol an ideal drug for long-term sedation. The present authors, however, are convinced that certain limitations must be taken into account. First, cardiovascular depression, especially if potentiated by drugs such as beta- and Ca-entry blockers, may lead to hypotensive episodes. Potential problems (drug tolerance, hypertriglyceridaemia) may be revealed in long-term studies. As long as no such studies have been presented, the authors believe that it is too early to consider propofol the ideal drug for long-term sedation.