Abstract Background and aims Inadequate sedation management following thrombectomy for acute ischemic stroke may lead to significant blood pressure fluctuations and consequently poor prognosis. The Bispectral Index (BIS) may help reduce blood pressure variability (BPV) during sedation. This study investigated the impact of short-term light sedation guided by the BIS on BPV and prognosis in patients after endovascular thrombectomy. Methods This retrospective study enrolled 126 patients who received post-thrombectomy sedation and analgesia. They were assigned to either a BIS-guided group (target BIS 60-80) or a control group managed using the Richmond Agitation-Sedation Scale (target RASS 0 to -2). Both groups received 4-6 hours of light sedation. Blood pressure data, clinical parameters, and 3-month follow-up outcomes (modified Rankin Scale, mRS) were collected and compared. Results Among 103 patients who completed follow-up, the primary analysis showed no significant intergroup differences in 3-month mRS scores, systolic/diastolic/mean arterial pressures (SBP/DBP/MAP), or their coefficients of variation (CV). However, a pre-specified subgroup analysis of patients whose BIS values were within the target range for 2/3 of the sedation period revealed significantly better BPV profiles compared to the control group. This subgroup demonstrated lower DBP (65.2 vs. 69.9 mmHg, P=0.045), DBP-CV (10.2% vs. 14.2%, P=0.023), MAP (86.5 vs. 90.5 mmHg, P=0.048), and MAP-CV (11.3% vs. 13.1%, P=0.046). Conclusions Effectively administered BIS-guided short-term light sedation may reduce diastolic and mean arterial pressure variability more effectively than RASS-based management in post-thrombectomy patients, suggesting a potential strategy for BPV control. Its relationship with long-term functional recovery warrants further investigation. Conflict of interest Name of author: nothing to disclose
Yang et al. (2026) studied this question.