key: cord-0958933-fl9zbgad
authors: Senthilkumaran, Subramanian; Murugan, Koushik; Sanjay, Patne; Thirumalaikolundusubramanian, Ponniah
title: Propofol in COVID 19 — From basic science to clinical impact
date: 2020-07-09
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2020.07.011
sha: 5849c060e179cef76cab11d19baa7f9ae741529e
doc_id: 958933
cord_uid: fl9zbgad

nan

J o u r n a l P r e -p r o o f increases angiotensin-converting enzyme2 (ACE2) expressions in human endothelial cells as mentioned by Sohn [2] . However, recently [3] it was demonstrated that propofol infusion increases ACE2 mediated conversion of angiotensin II to angiotensin, which results in a fall in angiotensin II levels and an elevation of angiotensin 1 to7; and these exhibit protective effects of lungs by way of recovery of endothelial cell function via an up-regulation of ACE2-Ang -Mas axis, subsequent to phosphorylation of endothelial nitric oxide (NO) synthase to generate NO, and regulation of apoptosis-related protein such as bcl-2, caspase9. Moreover, propofol also increases the concentration of cyclic guanosine monophosphate in cultured endothelial cells through a NO dependent mechanism [4] . In addition, propofol exerts its antioxidant property [5, 6] as evidenced by the inhibition of lipid peroxidase production in the platelet membrane and a decrease in tissue consumption of glutathione [7] .

Interestingly, its ability to inhibit inflammatory response was demonstrated by Taniguchi et al. [8] in the form of a reduction in the cytokine response (TNF-alpha and IL-8) and neutrophil infiltration in the lungs in endotoxemic rats received propofol infusion. Propofol also, prevents the development of metabolic acidosis during endotoxemia [8] . Apart from the antiinflammatory response, it also has an antithrombotic effect by way of inhibiting the platelet aggregation possibly in combination with the effects of the solvent, intralipid as well as increases leucocyte nitric oxide production, and inhibition of platelet thromboxane synthesis [9] . In view of the multiple protective actions, FDA of USA recently permitted the emergency use of the Fresenius Propoven 2% emulsion to maintain sedation via continuous infusion for COVID-19 patients older than 16 years who require mechanical ventilation [10].

To summarize, Propofol a short-acting intravenous sedative-hypnotic agent has multiple actions, including significant antioxidant and anti-inflammatory activities, apart from

Neuroleptic malignant syndrome in patients with COVID-19

Propofol and sedation in patients with coronavirus disease

Propofol prevents human umbilical vein endothelial cell injury from ang II-induced apoptosis by activating the ACE2-(1-7)-Mas axis and eNOS phosphorylation

Propofol stimulates nitric oxide release from cultured porcine aortic endothelial cells

The antioxidant potential of propofol (2,6-diisopropylphenol)

Effects of propofol on endothelial cells subjected to a peroxynitrite donor

Propofol: a review of its non-anaesthetic effects

Effects of propofol on hemodynamic and inflammatory responses to endotoxemia in rats

Antiplatelet effect of the anaesthetic drug propofol: influence of red blood cells and leucocytes