The purpose of this study is to compare two different methods of monitoring brain activity (anesthesia depth) during gynecological surgeries.

When patients undergo surgery under general anesthesia, doctors use monitors to ensure they are at the right level of sleep and pain relief. Traditionally, a method called the Bispectral Index (BIS) is used, which provides a single number to represent brain activity. A newer method, called Density Spectral Array (DSA), provides a more detailed, color-coded map of brain waves in real-time.

Researchers want to see if using the more detailed DSA map helps anesthesiologists adjust medication more precisely. The study will compare the total amount of anesthetic and pain-relief drugs used in patients monitored with DSA versus those monitored with BIS. The goal is to determine if DSA leads to more personalized care, potentially reducing drug use and improving recovery after surgery

This prospective observational study will include 45 patients undergoing elective gynecological oncology surgery under general anesthesia. Patients will be monitored using standard anesthesia monitoring (Pulse oximetry, non-invasive blood pressure, ECG, and ETCO2) along with brain activity monitoring.

The anesthesia management will follow a Total Intravenous Anesthesia (TIVA) protocol consisting of propofol, remifentanil, and lidocaine. Patients will be divided into two groups based on the anesthesiologist's preference for monitoring anesthesia depth: the Bispectral Index (BIS) group and the Density Spectral Array (DSA) group.

Hemodynamic parameters (heart rate, blood pressure), BIS values, and DSA images will be recorded at specific intervals: before induction, after induction, at the start of surgery, every 30 minutes during the procedure, at the end of surgery, and after extubation. The total amounts of propofol and remifentanil used during the operation will be documented for each patient.

In the postoperative period, patients will be monitored in the recovery unit at the 15th, 30th, and 60th minutes. Visual Analog Scale (VAS) scores for pain, additional analgesic requirements, and hemodynamic parameters will be recorded. Once orientation and cooperation are established, patients will also be evaluated for any signs of intraoperative awareness

Inclusion Criteria:

• Aged between 18 and 65 years
• ASA physical status I-III
• Patients scheduled for elective gynecological oncology surgery
• Body mass index (BMI) ≤ 35 kg/m²
• Able to provide voluntary informed consent
• Patients who do not require premedication

Exclusion Criteria:

• Allergy or hypersensitivity to propofol, opioids, or lidocaine
• Liver failure or kidney failure
• Previous adjuvant chemotherapy
• Emergency surgery
• Operations lasting longer than 3 hours
• Neurological diseases such as epilepsy, Alzheimer's disease, or dementia
• Cerebrovascular disease or known brain lesions
• Heart conduction disorders such as high-degree atrioventricular block
• Patients requiring premedication
• History of chronic pain
• Chronic opioid use
• Diabetes mellitus with neuropathy
• Patients unable to establish cooperation

This study is conducted on patients scheduled for elective gynecological oncology surgery; therefore, only female participants are eligible for inclusion.

The study population consists of female patients aged 18-65 years, with an ASA physical status of I-III, who are scheduled for elective gynecological oncology surgery under general anesthesia at a single tertiary oncology center. Participants are selected from patients who meet the inclusion criteria and do not require premedication, ensuring a standardized group for monitoring anesthesia depth and drug consumption.

Individual participant data (IPD) will not be shared to ensure patient confidentiality and data privacy, as per the institutional ethics committee guidelines. The study results will be disseminated through peer-reviewed publications and conference presentations in an aggregated format, ensuring that no individual patient can be identified.