Cerebral Aneurysms, Cerebral Aneurysm Unruptured, Unruptured Intracranial Aneurysm
Conditions
Keywords
Optic nerve sheath diameter, Intracranial pressure, Cerebral aneurysm, propofol, ketamine, neuroanesthesia
Brief summary
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.
Detailed description
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.
Interventions
General anesthesia maintained with propofol-based technique during endovascular treatment of unruptured intracranial aneurysms
General anesthesia maintained with a combination of propofol and ketamine during endovascular treatment of unruptured intracranial aneurysms.
Sponsors
Ankara City Hospital Bilkent
Uludag University
Study design
Observational model
OTHER
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Optic Nerve Sheath Diameter (ONSD) | From pre-induction (baseline) to end of procedure | 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. |
Secondary
| Measure | Time frame |
|---|---|
| Mean Arterial Pressure (MAP) | Mean arterial pressure was recorded at predefined time points, including pre-induction, intraoperative period at 5-minute intervals, and recovery. |
| Heart Rate | Heart rate was recorded at predefined time points, including pre-induction, intraoperative period at 5-minute intervals, and recovery. |
| EtCO₂ | End-tidal carbon dioxide levels were measured at predefined time points, including intraoperative period at 5-minute intervals. |
| rSO₂ | Regional cerebral oxygen saturation values were monitored continuously and recorded at predefined time points, including intraoperative period at 5-minute intervals. |
| Bispectral Index (BIS) | 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. |
Countries
Turkey (Türkiye)
Outcome results
None listed