Dear Editor, The spread of coronavirus disease (COVID-19) has led to an increasing number of severe cases, with many patients needing ventilation. In such cases, continuous sedation is required, and based on recent literature, ICU mortality is around 20–30%[1]. Sedatives currently used in clinical practice include midazolam, propofol, and dexmedetomidine. Propofol has several properties that make it a potentially superior choice for sedation of intubated ICU patients. Sedation with propofol can be rapidly commenced and terminated, even after prolonged administration, allowing for greater control over the level of sedation and faster weaning from mechanical ventilation. However, propofol has several drawbacks that should be considered, especially in COVID-19 patients.

In 2015, Schläpfer et al.[2] conducted a study using a rat sepsis model. They reported that all rats anaesthetised with propofol died within 24 hours, unlike those treated with other anaesthetics. If the infusion rate or the total dose is too high, intravenously infused lipid emulsions might inhibit the function of the reticuloendothelial system, resulting in immunosuppression [3]. Intravenously administered lipid emulsions bind to serum proteins, thereby forming lipoproteins. If the dose is too high, the fat droplets that do not form lipoproteins are treated by the body’s immune system as foreign substances and are phagocytosed by reticuloendothelial cells. This response might lead to a diminished immune reaction to other foreign substances such as bacteria and viruses.