Propofol is a lipid-soluble alkylphenol agent that is frequently used to sedate mechanically ventilated patients in the intensive care unit (ICU). It has many desirable properties of an ideal sedative. It crosses the blood-brain barrier rapidly and has a rapid onset of action. It is metabolized quickly to inactive metabolites, giving it a short duration of action. It is easy to titrate and no dose adjustment is necessary for hepatic or renal insufficiency. It is not associated with tolerance or withdrawal symptoms. Propofol decreases cerebral metabolism and cerebral blood flow, which results in a decrease in intracranial pressure. It has been used with benefit in trauma patients with brain injury. It has also been used for seizure control in status epilepticus when other therapeutic agents have failed. In addition, propofol can be used as a general anesthetic at higher doses and can provide some antegrade amnesia. However, it does not have analgesic properties and its amnestic properties are not reliable, so it is often used in conjunction with benzodiazepines or opiates.

In comparison with midazolam, propofol seems to be a better sedative in many ICU patients. It is more easily titratable, it can be reversed more quickly without the development of withdrawal or tolerance, and its use may decrease the need for muscle relaxants when propofol is used as a first-line agent for sedation. Of note, a reduced time to weaning from the ventilator has been shown with propofol use as compared with midazolam. Propofol and midazolam have also been used together (with or without narcotics) to minimize the shortcomings of each agent used alone.