Cerebral Oxygenation, Intracranial Pressure, Laparoscopic Hysterectomy, Lidocaine, Propofol, Sevoflurane
Conditions
Brief summary
This study will be conducted to evaluate the effects of different anesthetic modalities \[sevoflurane with or without intraoperative lidocaine infusion and Propofol total intravenous anesthesia (TIVA)\] on intracranial pressure (ICP) and cerebral oxygenation assessed by non-invasive methods during laparoscopic hysterectomy (LH).
Detailed description
Laparoscopic hysterectomy (LH) requires a Trendelenburg position (TP) and the creation of an artificial pneumoperitoneum (PP) by carbon dioxide insufflation. Various studies were done to evaluate the effects of different anesthesia techniques on intracranial pressure (ICP) during LH, and most of these studies revealed that propofol total intravenous anesthesia (TIVA) was superior to inhaled anesthesia regarding reduction of ICP (ONSD).
Interventions
DRUGPropofol
Patients' anesthesia will be maintained by manually adjusted propofol infusion at a rate of 100-250 mic/kg/min for bispectral index (BIS) maintained between 40-60.
DRUGSevoflurane plus lidocaine infusion
Sevoflurane with monitored anesthesia care (MAC) adjusted to maintain bispectral index (BIS) between 40-60 plus intravenous lidocaine infusion given as 2mg /kg IV bolus before induction then intraoperative infusion by a rate of 2 mg/kg/h until the end of surgery.
DRUGSevoflurane
Patients will receive sevoflurane with monitored anesthesia care (MAC) adjusted to maintain bispectral index (BIS) between 40-60.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age from 18 to 65 years. * American Society of Anesthesiologists (ASA) physical status I and Ⅱ. * Body mass index (BMI) ≤35. * Females scheduled for laparoscopic hysterectomy.
Exclusion criteria
* Patients' refusal to participate in the study. * Hypersensitivity and allergy to drugs of the study. * Contraindication for optic nerve sheath diameter assessment. E.g., patient with pre-existing ophthalmic diseases, a history of ophthalmic surgery * Any central nervous system or cardiovascular disease, severe hepatic or renal impairment * Intraoperative circumstances, such as inability to perform optic nerve sheath diameter or conversion to open surgery * If peak inspiratory pressure (PIP) exceeds 35.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Optic nerve sheath diameter | After extubating the endotracheal tube (up to one hour) | Optic nerve sheath diameter of both eyes is expressed in millimeters and will be assessed at times of: T0; baseline before induction, T1; after insertion of endotracheal tube, T2; just before pneumoperitoneum (PP), T3;30 minutes after PP and Trendelenburg position (TP),T4; 60 minutes after PP and TP,T5; Five minutes after disinflation of PP and T6;after extubating the endotracheal tube. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cerebral oxygenation | After extubating the endotracheal tube (up to one hour) | Cerebral oxygenation of both hemispheres by near-infrared spectroscopy (NIRS). normal values 60-70% and will be assessed at times of: T0; baseline before induction, T1; after insertion of endotracheal tube, T2; just before pneumoperitoneum (PP), T3;30 minutes after PP and Trendelenburg position (TP), T4; 60 minutes after PP and TP, T5; Five minutes after disinflation of PP and T6; after extubating the endotracheal tube. |
| Cognitive function | 4 hours postoperatively | Cognitive function by standardized mini mental state examination (SMMSE) preoperative, and 4hours postoperatively. |
| Incidence of postoperative complications | 24 hours postoperatively | Incidence of postoperative complications such as hypotension, bradycardia, postoperative nausea and vomiting (PONV), and headache will be recorded. |
Countries
Egypt
Contacts
Primary ContactEman A Elrefaey, Master
Outcome results
None listed