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

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.

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