Comparison of the effects of sedation agents used in emergency department on optic nerve sheath diameter

This study compares the effects of propofol and ketamine on intracranial pressure (İKB) using ocular ultrasonography (USG) and optic nerve sheath diameter (OSKÇ). This prospective thesis study, patients over 18 years of age without ocular disease and intracranial pathology who presented to the emergency department and underwent sedation between November 1, 2023 and May 31, 2025. Systolic and diastolic blood pressure, pulse rate and SpO2 were measured before sedation (PS) and after sedation (SS). OSKÇ measurements were performed for both eyes at 5 minutes before sedation and 5 minutes after sedation with ocular USG. Of the 68 patients included in the study, 31 (46%) received ketamine and 37 (54%) received propofol as sedative agents. The SD OSKÇ of ketamine was 3.86±0.53 mm in the right eye, 3.89±0.49 mm in the left eye, 3.86±0.56 mm in the right eye and 3.86±0.55 mm in the left eye. The OSKÇ value of propofol was 4.26±0.40 mm in the right eye, 4.30±0.43 mm in the left eye, 4.16±0.44 mm in the right eye and 4.16±0.47 mm in the left eye. No significant change in OSKÇ was observed after sedation with ketamine (P>0.05). after propofol sedation a statistically significant decrease in OSKÇ values were observed (P<0.05). İn patients treated with ketamine, There was no statistically significant change in vital signs after sedation (p>0.05). In patients treated with propofol, systolic and diastolic blood pressure, pulse rate and SpO2 values decreased after sedation (p<0.05). Ketamine can be safely used in patients with hemodynamic instability and/or suspected İKB increase as it does not cause significant changes in OSKÇ and vital signs. Propofol, on the other hand, has a moderate decreasing effect on OSKÇ and a significant decreasing effect on vital signs. It is recommended to use it in patients with suspected İKB rise and patients with stable hemodynamics. Keywords: Ketamine, propofol, intracranial pressure, optic nerve sheath diameter, ultrasonography