Oxidative stress exacerbates brain damage following
ischemia-reperfusion and
traumatic brain injury (TBI). Management of TBI and
critically ill patients commonly involves use of
propofol, a sedation medication that acts as a
general anesthetic with inherent
antioxidant properties. Here we review available evidence from animal model systems and clinical studies that
propofol protects against
ischemia-reperfusion injury. However, evidence of
propofol toxicity in humans exists and manifests as a rare complication, "
propofol infusion syndrome" (PRIS). Evidence in animal models suggests that
brain injury induces expression of the
p75 neurotrophin receptor (p75NTR), which is associated with proapoptotic signaling. p75NTR-mediated apoptosis of neurons is further exacerbated by
propofol's superinduction of p75NTR and concomitant inhibition of
neurotrophin processing.
Propofol is toxic to neurons but not astrocytes, a type of glial cell. Evidence suggests that
propofol protects astrocytes from oxidative stress and stimulates astroglial-mediated protection of neurons. One may speculate that in
brain injury patients under sedation/
anesthesia,
propofol provides brain tissue protection or
aids in recovery by enhancing astrocyte function. Nevertheless, our understanding of neurologic recovery versus long-term neurological sequelae leading to neurodegeneration is poor, and it is also conceivable that
propofol plays a partial as yet unrecognized role in long-term impairment of the injured brain.