Effect of dexmedetomidine combined with magnesium sulphate on intracranial tension in patients with severe pre-eclampsia using ultrasonographic optic nerve sheath Diameter - A randomised clinical trial.

Background and Aims: Prompt diagnosis and treatment of increased intracranial tension (ICT) critically impact outcomes in patients with severe pre-eclampsia. This study aimed to investigate the influence of dexmedetomidine (DEX) infusion on optic nerve sheath diameter (ONSD), utilised as a surrogate marker for ICT assessment, in pre-eclamptic patients presenting with severe features. Methods: Fifty parturients with a confirmed diagnosis of severe pre-eclampsia were included in the study cohort. Participants were randomly allocated to receive either a DEX infusion 0.2-0.7 μg/kg/h or a matching volume of 0.9% saline as a control, both regimens co-administered with standard magnesium sulphate therapy (4 g loading dose and 1 g/h maintenance). Infusions were continued until surgical completion. The primary outcome was ONSD measured at baseline and at 6, 12, 24, and 48 h post-infusion. Secondary outcomes included haemodynamic variables, sedation scores, neonatal APGAR scores, incidence of adverse events, and length of hospitalisation. Results: Both groups exhibited comparable demographic characteristics. ONSD showed significantly decreased values after DEX infusion compared to baseline ( Conclusion: Dexmedetomidine infusion in combination with magnesium sulphate effectively mitigates the elevation of intracranial tension observed in pre-eclamptic patients with severe features without increasing maternal or neonatal adverse events.