Desflurane combined with ciprofol or esketamine improves postoperative symptoms without compromising early neurocognitive recovery after intracranial aneurysm endovascular coiling.

OBJECTIVE

This randomized controlled trial aimed to compare the effects of three anesthetic regimens-desflurane + 0.9% saline (DS), desflurane + ciprofol (DC), and desflurane + esketamine (DE)-on early postoperative neurocognitive recovery and perioperative adverse events in patients undergoing endovascular coiling for intracranial aneurysms.

METHODS

This randomized controlled trial enrolled 210 patients scheduled for urgent endovascular coiling of intracranial aneurysms. Patients were randomly assigned in a 1:1:1 ratio to receive DS, DC, or DE. Neurocognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) before surgery, on postoperative day 1 (POD 1), and on postoperative day 5 (POD 5). Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), dizziness, numerical rating scale (NRS) pain scores, and the requirement for rescue antiemetic medication. This study was registered at the Chinese Clinical Trial Registry (ChiCTR2500097866).

RESULTS

The MoCA scores improved significantly over time across all groups (p < 0.001), with no significant differences in neurocognitive recovery trajectories among groups (interaction effect, p = 0.196; group effect, p = 0.729). The incidence of PONV differed significantly: 10.3% in the DC group, 17.9% in the DE group, and 44.9% in the DS group (p < 0.001). The DC group also exhibited the lowest incidence of dizziness (8.8%) and the lowest metoclopramide requirement (p = 0.012). Postoperative pain scores were significantly lower in the DE group than in the DC group (adjusted p = 0.026).

CONCLUSION

In patients undergoing endovascular coiling for intracranial aneurysms, desflurane-based anesthesia supplemented with ciprofol or esketamine does not compromise early neurocognitive recovery. Desflurane plus ciprofol effectively reduces PONV and dizziness, whereas desflurane plus esketamine provides superior analgesia. These findings support personalized, symptom-targeted anesthetic strategies to enhance perioperative safety and recovery.