Effect of Total Intravenous versus Inhalational Anesthesia on Optic Nerve Sheath Diameter as an Index of Intra Cranial Pressure Changes in Pediatric Open Cardiac Surgery: A Randomized Controlled Study

Background: Despite advancements in pediatric cardiac surgical care, adverse neurological outcomes, including changes in intracranial pressure (ICP), can occur following cardiopulmonary bypass (CPB). Optic nerve sheath diameter (ONSD) measurement via bedside ultrasound is a non-invasive, reliable surrogate for ICP, offering an alternative to invasive monitoring. Anesthetic agents can influence ICP.
Objective: This study aimed to compare the effect of total intravenous anesthesia (TIVA) versus inhalational anesthesia on ONSD as an indicator of ICP changes in children undergoing open cardiac surgery.
Methods: This prospective, randomized, open-label, controlled study included 80 children (6 months to 16 years, ASA (II-III) undergoing elective open cardiac surgery. Patients were randomized to TIVA (propofol-based) or inhalational (sevoflurane-based) groups. ONSD was measured at three time points: Post-induction (T1), post-CPB separation (T2) and post-surgical closure (T3). Secondary outcomes included hemodynamic parameters, surgical times, and ICU stay.
Results: No significant differences were observed between groups in patient characteristics, surgical durations, or physiological parameters at T1 and T2. However, at T3, ONSD was significantly greater in the inhalational group (3.35 ± 0.21 mm) compared to the TIVA group (3.03 ± 0.15 mm) ($P \< 0.001$).
Conclusion: Total intravenous anesthesia resulted in a significantly lesser changes in optic nerve sheath diameter at the end of pediatric open cardiac surgery compared to inhalational anesthesia, suggesting a more favorable ICP profile. TIVA should be considered for children undergoing open heart surgery to potentially mitigate ICP increase.