Clinical Report: Effects of Desflurane with Ciprofol or Esketamine on Postoperative Outcomes

Overview

This randomized controlled trial evaluated the impact of desflurane combined with ciprofol or esketamine on neurocognitive recovery and postoperative outcomes in patients undergoing endovascular coiling for intracranial aneurysms. The study found that while neurocognitive recovery was similar across groups, desflurane with ciprofol significantly reduced postoperative nausea and vomiting (PONV) and dizziness compared to desflurane alone.

Background

Intracranial aneurysms pose a significant risk of subarachnoid hemorrhage, necessitating effective surgical interventions like endovascular coiling. Postoperative neurocognitive dysfunction is a common complication that can adversely affect long-term patient outcomes. Optimizing anesthetic regimens is crucial for enhancing recovery and minimizing adverse effects during these procedures.

Data Highlights

Key Findings

• No significant differences in neurocognitive recovery trajectories among groups (p = 0.729).
• Improvement in MoCA scores over time across all groups (p < 0.001).
• DC group had the lowest incidence of PONV (10.3%) compared to DE (17.9%) and DS (44.9%) (p < 0.001).
• DC group also exhibited the lowest incidence of dizziness (8.8%) (p = 0.012).
• Postoperative pain scores were significantly lower in the DE group compared to the DC group (adjusted p = 0.026).

Clinical Implications

The findings suggest that combining desflurane with ciprofol may be beneficial in reducing postoperative nausea and dizziness, enhancing patient comfort. Conversely, desflurane with esketamine may provide better analgesia, indicating the importance of personalized anesthetic strategies based on patient needs.

Conclusion

Desflurane-based anesthesia supplemented with ciprofol or esketamine does not compromise neurocognitive recovery and offers distinct advantages in managing postoperative symptoms. These results support tailored anesthetic approaches to improve patient outcomes following endovascular coiling for intracranial aneurysms.

Related Resources & Content

1. Acta Neurochirurgica, 2023 -- Integrated neuropsychological assessment in patients undergoing neurosurgical and endovascular treatment of unruptured cerebral aneurysms: results of a prospective observational study
2. Acta Neurochirurgica, 2023 -- Administration of full cangrelor dosage for the immediate management of small ruptured cerebral aneurysms using flow diverters: insights from a single institution study
3. Journal of Neuro-Oncology, 2014 -- Efficacy of postoperative seizure prophylaxis in intra-axial brain tumor resections
4. Critical Care (Springer), 2026 -- Propofol versus sevoflurane: how many RCTs is enough?
5. 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association - PubMed
6. Comparison of Volatile Anesthetics Versus Propofol on Postoperative Cognitive Function After Cardiac Surgery: A Systematic Review and Meta-analysis - PubMed
7. Effect of esketamine on postoperative delirium in general anesthesia patients undergoing elective surgery: a meta-analysis of randomized controlled trials | BMC Anesthesiology | Springer Nature Link
8. 2023 AHA/ASA Guidelines for Aneurysmal Subarachnoid Hemorrhage
9. Volatile Anesthetics and Postoperative Cognition
10. Effect of esketamine on postoperative delirium in general anesthesia patients undergoing elective surgery: a meta-analysis of randomized controlled trials | BMC Anesthesiology | Springer Nature Link