Luís Almeida-Jardim, Paulo Reis-Pina
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.