Remifentanil vs Esmolol During Intubation for Cerebral Aneurysm Coil Embolization

NCT07660861 | Not Yet Recruiting

• 1 other identifier: ONSD/ETD
• Study Type: interventional
• Target: 84
• Locations: 1 country
• Sites: 1

Brief Summary

Endotracheal intubation may cause significant increases in blood pressure, heart rate, and intracranial pressure, particularly in patients undergoing cerebral aneurysm coil embolization. Remifentanil and esmolol are commonly used agents to attenuate these responses during anesthesia induction. This randomized controlled trial aims to compare the effects of remifentanil and esmolol administered before endotracheal intubation on optic nerve sheath diameter/eyeball transverse diameter ratio (ONSD/ETD), a noninvasive surrogate marker of intracranial pressure, as well as hemodynamic responses in patients undergoing elective cerebral aneurysm coil embolization. The findings may help identify the most effective strategy for minimizing intubation-related intracranial pressure changes and hemodynamic fluctuations in neurointerventional anesthesia practice.

Conditions

Cerebral Aneurysm Unruptured; Intracranial Pressure

Keywords

Optic Nerve Sheath Diameter; Intracranial Pressure; Remifentanil; Esmolol; Coil Embolization

Outcome Measures

Primary Outcomes (1)

• Change in ONSD/ETD Ratio at 5 Minutes After Endotracheal Intubation

  Difference between baseline (pre-intubation) and 5-minute post-intubation optic nerve sheath diameter-to-eyeball transverse diameter ratio (ONSD/ETD).

  5 minutes after endotracheal intubation

Secondary Outcomes (4)

• Change in ONSD/ETD Ratio at 10 Minutes After Endotracheal Intubation

  10 minutes after endotracheal intubation

• Change in Mean Arterial Pressure

  Baseline, 5 minutes, and 10 minutes after intubation

• Change in Heart Rate

  Baseline, 5 minutes, and 10 minutes after intubation

• Vasopressor Requirement

  From intubation until 10 minutes after intubation

Study Arms (2)

remifentanil group

EXPERIMENTAL

Participants will receive remifentanil 0.5-1 µg/kg intravenously over 90 seconds before endotracheal intubation during induction of general anesthesia for elective cerebral aneurysm coil embolization.

Drug: Remifentanil

Esmolol Group

ACTIVE COMPARATOR

Participants will receive esmolol 0.5-1 mg/kg intravenously over 90 seconds before endotracheal intubation during induction of general anesthesia for elective cerebral aneurysm coil embolization.

Drug: Esmolol

Interventions

Remifentanil DRUG

Remifentanil 0.5-1 µg/kg IV administered over 90 seconds before endotracheal intubation.

remifentanil group

Esmolol DRUG

Esmolol 0.5-1 mg/kg IV administered over 90 seconds before endotracheal intubation.

Esmolol Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age ≥18 years
• American Society of Anesthesiologists (ASA) physical status I-III
• Scheduled for elective cerebral aneurysm coil embolization under general anesthesia
• Planned endotracheal intubation
• Ability to provide written informed consent

You may not qualify if:

• Emergency procedures
• Hemodynamic instability before induction of anesthesia
• Severe cardiac conduction abnormalities or clinically significant arrhythmias
• Contraindication or allergy to remifentanil or esmolol
• Chronic opioid use or opioid dependence
• Known orbital disease, ocular trauma, or conditions interfering with optic nerve sheath diameter measurements
• Anticipated difficult airway
• Pregnancy
• Refusal to participate in the study

Sponsors & Collaborators

• Fatih Sultan Mehmet Training and Research Hospital: lead

Study Sites (1)

Fatih Sultan Mehmet Training and Research Hospital

Istanbul, Istanbul, 34752, Turkey (Türkiye)

Location

Related Publications (3)

• Öner, Ö., & Yıldız, E. (2020). Comparison of The Effects of Remifentanil, Fentanyl, Esmolol, Lidocaine, and Amiodarone in Preventing Hemodynamic Response to Intubation. Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi, 15(3), 22-29. https://doi.org/10.17517/ksutfd.673702

  BACKGROUND

• Kim KH, Kang HK, Koo HW. Prediction of Intracranial Pressure in Patients with an Aneurysmal Subarachnoid Hemorrhage Using Optic Nerve Sheath Diameter via Explainable Predictive Modeling. J Clin Med. 2024 Apr 4;13(7):2107. doi: 10.3390/jcm13072107.

  PMID: 38610872 BACKGROUND

• Fu H, Hu J, Zhang X, Xie K, Hu L. Effect of different anesthesia strategies on intracranial pressure during extubation after intracranial aneurysm embolization: a randomized controlled trial. Sci Rep. 2026 Apr 18. doi: 10.1038/s41598-026-49045-6. Online ahead of print.

  PMID: 42000868 RESULT

MeSH Terms

Interventions

Remifentanil; esmolol

Intervention Hierarchy (Ancestors)

Propionates; Acids, Acyclic; Carboxylic Acids; Organic Chemicals; Piperidines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds

Central Study Contacts

Arsen Güngör Ay, MD

CONTACT

+905534948426; arsen.gungor@hotmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Participants undergoing elective cerebral aneurysm coil embolization under general anesthesia will be randomly assigned in a 1:1 ratio to receive either remifentanil or esmolol before endotracheal intubation. Outcomes will be compared between the two parallel groups.

Study Record Dates

• First Submitted: June 16, 2026
• First Posted: June 22, 2026
• Study Start: June 22, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): July 1, 2027
• Last Updated: June 22, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)