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Sedation in Acute Ischemic Stroke: Pathophysiological Basis and Evidence for Commonly Used Agents
Costanza Gandolfo1,2, Denise Battaglini3,4, Chiara Robba1,2
1Anaesthesia and Intensive Care, IRCCS Azienda Ospedaliera Metropolitana, Genoa, Italy.
Translational Stroke Research
|July 3, 2026
Summary
Sedatives like propofol, dexmedetomidine, and ketamine may offer neuroprotection in acute ischemic stroke (AIS). Further trials are needed to optimize their use beyond comfort and procedural facilitation for better patient outcomes.
Area of Science:
- Neurocritical care
- Stroke medicine
- Pharmacology
Background:
- Sedation is crucial for acute ischemic stroke (AIS) management but its therapeutic potential is underutilized.
- Current clinical practice insufficiently integrates the impact of sedatives on secondary brain injury and systemic complications.
Purpose of the Study:
- To review experimental and clinical evidence on the biological effects of propofol, dexmedetomidine, and ketamine in AIS.
- To explore the potential of these sedatives as active therapeutic agents in AIS management.
Main Methods:
- Narrative review of experimental and clinical studies.
- Analysis of biological effects of propofol, dexmedetomidine, and ketamine.
- Examination of clinical data on neurological recovery and organ function.
Main Results:
- Experimental data suggest propofol reduces oxidative injury, dexmedetomidine attenuates neuroinflammation, and ketamine limits excitotoxicity.
- Clinical data, though limited, indicate sedative choice may impact neurological recovery and organ function.
- Potential benefits must be balanced against known risks like hemodynamic instability.
Conclusions:
- Sedatives may possess neuroprotective and systemic effects beyond comfort provision in AIS.
- Standardized sedation strategies and rigorous clinical trials are necessary to define optimal integration of these agents.
- Further research is needed to harness the therapeutic potential of sedatives in early stroke care.
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