Long durations of the Valsalva maneuver during high-intensity focused ultrasound liver ablation significantly worsen brain function outcomes.

• Burst suppression rates soared to 66.7% with >5.2-minute Valsalva episodes, compared to 2.0% in the control group (p < 0.001).
• Emergence agitation was notably higher in the long Valsalva group at 64.7%, versus only 2.0% in controls (p < 0.001).

Consider limiting Valsalva maneuver episodes to ≤5.2 minutes to improve recovery quality and minimize complications.

• The long Valsalva group also had the lowest quality of recovery scores (106 vs 110 in control).