The Effect of Obesity on the Incidence of Postoperative Cognitive Dysfunction in Gynecological Day Case Surgery

Study Overview
=================
Brief Summary
-----------------
Cognitive dysfunction is the impairment of mental process of perception. memory and information processing which allow the human to acquire knowledge and plan for the future. The etiology of Post operative cognitive dysfunction (POCD) is unclear and seems to be multifactorial involving a combination of patient, surgical, anesthetic and environmental factors. The definition of day surgery in Great Britain and Ireland is clear; the patient is admitted and discharged on the same day.

Detailed Description
-----------------
Cognitive dysfunction is the impairment of mental process of perception. memory and information processing which allow the human to acquire knowledge and plan for the future. The etiology of Post operative cognitive dysfunction (POCD) is unclear and seems to be multifactorial involving a combination of patient, surgical, anesthetic and environmental factors. It can be a manifestation of transient or permanent cerebral injury. While cognitive function tends to improve overmonths to years postoperatively in affected individuals, some proportion has seemingly permanent cognitive injury. Most of the studies of POCD, however, have methodological difficulties, as pointed out by Newman and colleagues in their review of more than 40 studies. The overweight/obese population has been steadily increasing worldwide. According to the WHO, with1.3 billion overweight (25 < body mass index [BMI] < 30) people and 600 million obese (BMI > 30) people in the world, the obesity rate exceeds10% for both genders and has more than doubled during the past 40 years. Furthermore, It considered as seven of the top10 causes of death / physical disability and chronic disorders such as cancer and diabetes, which are closely related to obesity. The definition of day surgery in Great Britain and Ireland is clear; the patient is admitted and discharged on the same day, with day surgery as the intended management. The term '23-h stay' is used in the United states healthcare system. Obesity itself is not a contraindication to day surgery, as morbidly obese patients can be safely managed by experts, provided appropriate resources are available. This includes factoring in additional time for anaesthesia and surgery as well as the presence of skilled assistants and equipment. The incidence of complications during the operation or in the early recovery phase is greater in patients with increasing body mass index. However, these problems would still occur with inpatient care and have usually resolved or been successfully treated by the time a day-case patient would be discharged. In addition, obese patients benefit from short-duration anaesthetic techniques and early mobilisation associated with day surgery. Our study will aim to assess the early cognitive dysfunction after general anesthesia in normal weight patients, overweight and mild obese patients in gynacological day-case surgery.

Official Title
-----------------
The Effect of Obesity on the Incidence of Postoperative Cognitive Dysfunction in Gynecological Day-case Surgery

Conditions
-----------------
Postoperative Cognitive Dysfunction

Intervention / Treatment
-----------------
* Behavioral: Effect of Obesity on incidence of Postoperative cognitive in Gynecological Day- Day- case surgery


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients aging 20_40 years, ASA physical status I undergoing hysteroscopy procedures All patients can read and write well Exclusion Criteria: Patients not ASA1 Patients receiving sedatives as midazolam. Pregnant Patients . Patients with cerebrovascular diseases . Patients with history of allergy to the drugs used in the study or patients with substance abuse . Time of anesthesia less than 30 minute ,or more than one hour . Irrigation fluid rather than warm saline(40 degree ) or fluid volume more than 1500 ml

Ages Eligible for Study
-----------------
Minimum Age: 20 Years
Maximum Age: 40 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Average weight .control group<br>Average weight BMI (18.5_25) | |
| Active Comparator: Overweight<br>Overweight BMI ( 25_30 ) | Behavioral: Effect of Obesity on incidence of Postoperative cognitive in Gynecological Day- Day- case surgery<br>* The effect of obesity on the incidence of postoperative cognitive dysfunction in Gynecological day-case surgery<br>|
| Active Comparator: Mild obese<br>Mild obese BMI (30_35 ) | Behavioral: Effect of Obesity on incidence of Postoperative cognitive in Gynecological Day- Day- case surgery<br>* The effect of obesity on the incidence of postoperative cognitive dysfunction in Gynecological day-case surgery<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative cognitive dysfunction( POCD ) | Mini Mental State a practical method for grading the cognitive state ( Max score 30 degree ) Orientation 10 degree , Registration 3 degree , Attention&Calculation 5 degree , Recall 3 degree , language 9 degree . Decrease 2 or more than Preoperative score will indicate POCD. | 1 hour Preoperative _ then 1 hour , 6 hours and 24 hour postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| weight ln kilograms (KG ) and Height in meters (M ) will be combined to report Body mass index (BMI ) . BMI = KG/ M^2 . | To show the effect of obesity on POCD | Preoperative. | 
| Vital signs: HR (beat/min), MAP (mmHg) and peripheral Oxygen saturation (Spo2) % | To make other factors irrelevant | immediately prior to induction of anesthesia and subsequently every 5 min till the termination of anesthesia. | 
| Time of surgery in minutes | To make other factors irrelevant | Intraoperative | 
| AGE in years | To make other factors irrelevant | Preoperative | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Obesity, Day-case Surgery, Postoperative cognitive dysfunction