Comparison of Propofol and Propofol-Ketamine Anesthesia on Optic Nerve Sheath Diameter in Endovascular Cerebral Aneurysm Procedures

N/ACompletedNCT07542015

Ankara City Hospital Bilkent46 enrolled

Overview

This study aimed to compare the effects of propofol-based anesthesia and propofol-ketamine anesthesia on optic nerve sheath diameter (ONSD) in patients undergoing elective endovascular treatment of unruptured intracranial aneurysms. ONSD, measured using ultrasonography, is a non-invasive surrogate marker of intracranial pressure. In addition, intraoperative hemodynamic parameters, cerebral oxygenation, and anesthetic requirements were evaluated to assess the safety and physiological impact of the two anesthesia techniques.

Endovascular treatment of unruptured intracranial aneurysms requires anesthetic strategies that maintain cerebral perfusion and hemodynamic stability while minimizing increases in intracranial pressure. Optic nerve sheath diameter (ONSD) measurement using ultrasonography is a widely accepted non-invasive method for assessing intracranial pressure changes. This study included adult patients who underwent elective endovascular treatment for unruptured intracranial aneurysms. Patients were managed with either propofol-based anesthesia or a combination of propofol and ketamine according to routine clinical practice. ONSD measurements were performed at predefined time points during the perioperative period, and changes in ONSD were analyzed. In addition, intraoperative mean arterial pressure, heart rate, end-tidal carbon dioxide levels, regional cerebral oxygen saturation, vasopressor requirements, and total anesthetic consumption were recorded. The primary objective of the study was to compare changes in ONSD between the two anesthesia techniques. Secondary objectives included evaluation of hemodynamic stability, cerebral oxygenation, and anesthetic requirements.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Unruptured Intracranial Aneurysm Cerebral Aneurysm Unruptured

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age between 18 and 75 years * Patients scheduled for elective endovascular treatment of unruptured intracranial aneurysms * ASA physical status I-III * Glasgow Coma Scale score of 15 * Ability to read and write and provide written informed consent Exclusion Criteria: * Age under 18 or over 75 years * ASA physical status IV or higher * History of ocular disease or previous eye surgery * Presence of giant aneurysm * Increased intracranial pressure * Coronary artery disease * Psychiatric or neurological disorders interfering with consent or assessment * Emergency surgical indication

Outcomes

Primary Outcomes

Change in Optic Nerve Sheath Diameter (ONSD)

Optic nerve sheath diameter (ONSD) was measured using ultrasonography at five predefined time points: pre-induction (baseline), pre-intubation, post-intubation, end of procedure, and recovery period. The primary outcome was the change in ONSD from baseline to the end of the procedure. Measurements were obtained bilaterally at 3 mm behind the globe and averaged.

Time frame: From pre-induction (baseline) to end of procedure

Secondary Outcomes

Mean Arterial Pressure (MAP)

Time frame: Mean arterial pressure was recorded at predefined time points, including pre-induction, intraoperative period at 5-minute intervals, and recovery.

Heart Rate

Time frame: Heart rate was recorded at predefined time points, including pre-induction, intraoperative period at 5-minute intervals, and recovery.

EtCO₂

Time frame: End-tidal carbon dioxide levels were measured at predefined time points, including intraoperative period at 5-minute intervals.

rSO₂

Time frame: Regional cerebral oxygen saturation values were monitored continuously and recorded at predefined time points, including intraoperative period at 5-minute intervals.

Bispectral Index (BIS)

Time frame: Bispectral index values were recorded to monitor depth of anesthesia at predefined time points, including pre-induction, intraoperative period at 5-minute intervals, and recovery.