About this trial
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).
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
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.
Disqualifiers
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
Trial design
Parallel
Treatments tested in this trial
Propofol
DrugPatients' 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.
Sevoflurane plus lidocaine infusion
DrugSevoflurane 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.
Sevoflurane
DrugPatients will receive sevoflurane with monitored anesthesia care (MAC) adjusted to maintain bispectral index (BIS) between 40-60.
Treatment groups
Trial outcomes
Primary outcomes
Optic nerve sheath diameter
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 outcomes
Cerebral oxygenation
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
Cognitive function by standardized mini mental state examination (SMMSE) preoperative, and 4hours postoperatively.
Incidence of postoperative complications
Incidence of postoperative complications such as hypotension, bradycardia, postoperative nausea and vomiting (PONV), and headache will be recorded.
Sponsors and contacts
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