Intracranial Pressure, Laparoscopic Surgery, Optic Nerve Sheath Diameter
Conditions
Keywords
Sevoflurane, Desflurane, Trendelenburg Position
Brief summary
Laparoscopic surgeries require pneumoperitoneum and Trendelenburg position, which may lead to increased intracranial pressure (ICP). Optic nerve sheath diameter (ONSD) measurement via ultrasound is a non-invasive method to evaluate ICP. This prospective study aims to compare the effects of sevoflurane and desflurane on ONSD in patients undergoing laparoscopic hysterectomy and bilateral oophorectomy in the Trendelenburg position.
Detailed description
The primary objective of this study is to compare the ONSD values measured by ultrasound between the sevoflurane and desflurane groups.
Interventions
DRUGSevoflurane
Anesthesia maintenance will be provided with sevoflurane at 1 MAC in a 40% oxygen-air mixture.
DRUGDesflurane
Anesthesia maintenance will be provided with desflurane at 1 MAC in a 40% oxygen-air mixture.
Sponsors
Medipol University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Patients planned for laparoscopic hysterectomy bilateral oophorectomy surgery under general anesthesia. * ASA physical status I-II
Exclusion criteria
* Patients receiving beta-blocker or diuretic treatment. * Patients with severe heart failure. * Patients diagnosed with diabetes with ocular or neurological complications. * Patients who have undergone cardiac surgery, eye surgery, brain surgery, or thoracic surgery. * Patients with a history of hydrocephalus, glaucoma, intracranial mass, and stroke. * History of allergy to the study drugs * Known or suspected pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Optic Nerve Sheath Diameter (ONSD) | T1: after intubation, before 1.0 MAC (supine); T2: on reaching 1.0 MAC (supine); T3: 10 min after pneumoperitoneum and steep Trendelenburg; T4: 60 min after pneumoperitoneum and steep Trendelenburg; T5: 10 min after desufflation, supine | ONSD measured by transorbital ultrasound with a 7.5-15 MHz linear probe, 3.0 mm behind the posterior globe wall, between the outer edges of the dural sheath. At least three measurements are obtained from each eye and averaged. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean Arterial Pressure (MAP) | T1: after intubation, before 1.0 MAC (supine); T2: on reaching 1.0 MAC (supine); T3: 10 min after pneumoperitoneum and steep Trendelenburg; T4: 60 min after pneumoperitoneum and steep Trendelenburg; T5: 10 min after desufflation, supine | Mean arterial pressure will be measured via non-invasive blood pressure monitoring or invasive radial artery cannulation. |
| Peripheral Oxygen Saturation (SpO2) | T1: after intubation, before 1.0 MAC (supine); T2: on reaching 1.0 MAC (supine); T3: 10 min after pneumoperitoneum and steep Trendelenburg; T4: 60 min after pneumoperitoneum and steep Trendelenburg; T5: 10 min after desufflation, supine | Oxygen saturation will be monitored continuously using pulse oximetry. |
| End-tidal Carbon Dioxide (EtCO2) | T1: after intubation, before 1.0 MAC (supine); T2: on reaching 1.0 MAC (supine); T3: 10 min after pneumoperitoneum and steep Trendelenburg; T4: 60 min after pneumoperitoneum and steep Trendelenburg; T5: 10 min after desufflation, supine | End-tidal carbon dioxide levels will be measured using capnography monitoring. |
| Arterial pH | T1: after intubation, before 1.0 MAC (supine); T2: on reaching 1.0 MAC (supine); T3: 10 min after pneumoperitoneum and steep Trendelenburg; T4: 60 min after pneumoperitoneum and steep Trendelenburg; T5: 10 min after desufflation, supine | Arterial pH levels will be evaluated from arterial blood gas analysis samples. |
| Partial Pressure of Carbon Dioxide (pCO2) | T1: after intubation, before 1.0 MAC (supine); T2: on reaching 1.0 MAC (supine); T3: 10 min after pneumoperitoneum and steep Trendelenburg; T4: 60 min after pneumoperitoneum and steep Trendelenburg; T5: 10 min after desufflation, supine | pCO2 levels will be evaluated from arterial blood gas analysis samples. |
| Change in optic nerve sheath diameter between consecutive study phases (Δ ONSD) | T1: after intubation, before 1.0 MAC (supine); T2: on reaching 1.0 MAC (supine); T3: 10 min after pneumoperitoneum and steep Trendelenburg; T4: 60 min after pneumoperitoneum and steep Trendelenburg; T5: 10 min after desufflation, supine | Within-patient change in ONSD between consecutive time points (Δ T1-T2, Δ T2-T3, Δ T3-T4, Δ T4-T5) and across the whole procedure (Δ T1-T4, Δ T1-T5), compared between the sevoflurane and desflurane groups. |
| Arterial lactate | T1: after intubation, before 1.0 MAC (supine); T2: on reaching 1.0 MAC (supine); T3: 10 min after pneumoperitoneum and steep Trendelenburg; T4: 60 min after pneumoperitoneum and steep Trendelenburg; T5: 10 min after desufflation, supine | Arterial lactate measured from arterial blood gas samples. |
| Peak airway pressure | T1: after intubation, before 1.0 MAC (supine); T2: on reaching 1.0 MAC (supine); T3: 10 min after pneumoperitoneum and steep Trendelenburg; T4: 60 min after pneumoperitoneum and steep Trendelenburg; T5: 10 min after desufflation, supine | Peak inspiratory airway pressure recorded from the anaesthesia ventilator. |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORBurak Ömür
Medipol University
Outcome results
None listed