Objectives: this study aims at assessment of acute inflammatory response; measured by high sensitivity\r\nC-reactive protein (hs-CRP), and myocardial injury; measured by serum cardiac troponin-T (Tn-T) in patients\r\nundergoing elective major abdominal cancer surgery with general anaesthesia or combined general and lumbar\r\nepidural anesthesia.\r\nMethods: The study included 60 ischemic patients undergoing elective major abdominal cancer surgery with risk\r\nfactor(s) like(history of myocardial infraction, diabetes, hypertension, obesity or heavy smoking)randomly assigned\r\ninto 2 groups; 30 patients each to receive general anesthesia (G1) or combined general and epidural anesthesia\r\n(G2). Pain severity, time to first request of rescue analgesic, analgesic consumption, hemodynamics and side effects\r\nwere recorded in first 72 hrs postoperative. Serum Tn-T and hs-CRP, ECG were assessed peroperatively and 1,2,3\r\ndays postoperativly also 12-lead ECGs were recorded before and 1,2,3 days after surgery.\r\nResults: The mean VAS scores were significantly reduced in G2 allover time in comparison to G1 (p<0.05)\r\nexcept at 32hrs postoperatively. Mean time to first request for rescue analgesic was significantly prolonged in G2\r\ncompared to G1 (p=0.001). Mean morphine consumption was significantly reduced in G2 (p<0.001). Mean serum\r\nlevel of CPR increased in both groups. Mean level of serum troponin-T was significantly increased only in G1\r\ncompared to baseline value (p<0.05) with no significant difference between G1 and G2. There were 5 patients\r\n(16.6%) in G1 and 2 patients (6.6%) in G2 showed serum troponin-T level > 0.03ng/ml. Regarding ECGs changes\r\nthere were 2 patients (6.6%) in G1 and one patient (3.3%) in G2 showed new ischemic changes postoperatively in\r\nthe form of depressed ST segment >1mm.\r\nConclusion: The use of LEA with general anesthesia in high risk patients with ischemic heart disease undergoing\r\nmajor non-cardiac surgery is associated with less perioperative acute inflammatory response, less post-operative\r\npain and can reduce the perioperative myocardial damage.
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