Effect of different anesthesia strategies on intracranial pressure during extubation after intracranial aneurysm...

Intracranial pressure (ICP) fluctuations during the extubation period pose a risk of severe complications in patients undergoing intracranial procedures. Transorbital sonography was used to measure the ratio of optic nerve sheath diameter (ONSD) to eyeball transverse diameter (ETD), which has emerged as a novel non-invasive method for ICP monitoring. This study aimed to evaluate the effects of different anesthesia strategies on extubation-period ICP, using the ONSD/ETD ratio as a surrogate marker. This prospective randomized controlled trial enrolled 63 patients, who were assigned to three groups: control group (Group C), remifentanil group (Group R), and dexmedetomidine group (Group D). Group R received a continuous infusion of remifentanil during the extubation period; Group D received a continuous infusion of dexmedetomidine, which was discontinued 30 min before the end of surgery; Group C received no additional intervention. At immediate extubation (T1) and 5 min post-extubation (T2), the ONSD/ETD ratio was significantly elevated across all three groups. Notably, compared with Group C, Groups R and D exhibited lower ONSD/ETD ratios at T1 and T2, a reduced incidence of moderate-to-severe cough, and lower heart rate (HR) and mean arterial pressure (MAP) during extubation. However, Group D had a significantly longer extubation time. The ultrasound-derived ONSD/ETD ratio is an effective tool for monitoring ICP during the extubation period. Both remifentanil and dexmedetomidine can alleviate the trend of extubation-induced ICP elevation, though dexmedetomidine is associated with a higher risk of bradycardia and prolonged extubation.Clinical trial registration The trial was prospectively registered on the National Health Insurance Information Platform on 01-07-2023 (Registration No.: MR-33-23-020942) and retrospectively registered on the Chinese Clinical Trial Registry (ChiCTR) on 06-05-2024 (Registration No.: ChiCTR2400083815).