The Effect of Anesthetic Technique on Cardiac Troponin-T and Systemic Inflammatory Response after Major Abdominal Cancer Surgery
- *Corresponding Author:
- Sahar A. Mohamed
Intensive care and pain management
South Egypt Cancer Institute
Assiut University, Assiut, Egypt
Tel: 002- 010-03611410
E-mail: [email protected]
Received date: February 06, 2013; Accepted date: March 14, 2013; Published date: March 18, 2013
Citation: Mohamed SA, Fares KM, Hasan-Ali H, Bakry R (2013) The Effect of Anesthetic Technique on Cardiac Troponin-T and Systemic Inflammatory Response after Major Abdominal Cancer Surgery. J Anesthe Clinic Res 4:296. doi: 10.4172/2155-6148.1000296
Copyright: © 2013 Mohamed SA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objectives: this study aims at assessment of acute inflammatory response; measured by high sensitivity C-reactive protein (hs-CRP), and myocardial injury; measured by serum cardiac troponin-T (Tn-T) in patients undergoing elective major abdominal cancer surgery with general anaesthesia or combined general and lumbar epidural anesthesia.
Methods: The study included 60 ischemic patients undergoing elective major abdominal cancer surgery with risk factor(s) like(history of myocardial infraction, diabetes, hypertension, obesity or heavy smoking)randomly assigned into 2 groups; 30 patients each to receive general anesthesia (G1) or combined general and epidural anesthesia (G2). Pain severity, time to first request of rescue analgesic, analgesic consumption, hemodynamics and side effects were recorded in first 72 hrs postoperative. Serum Tn-T and hs-CRP, ECG were assessed peroperatively and 1,2,3 days postoperativly also 12-lead ECGs were recorded before and 1,2,3 days after surgery.
Results: The mean VAS scores were significantly reduced in G2 allover time in comparison to G1 (p<0.05) except at 32hrs postoperatively. Mean time to first request for rescue analgesic was significantly prolonged in G2 compared to G1 (p=0.001). Mean morphine consumption was significantly reduced in G2 (p<0.001). Mean serum level of CPR increased in both groups. Mean level of serum troponin-T was significantly increased only in G1 compared to baseline value (p<0.05) with no significant difference between G1 and G2. There were 5 patients (16.6%) in G1 and 2 patients (6.6%) in G2 showed serum troponin-T level > 0.03ng/ml. Regarding ECGs changes there were 2 patients (6.6%) in G1 and one patient (3.3%) in G2 showed new ischemic changes postoperatively in the form of depressed ST segment >1mm.
Conclusion: The use of LEA with general anesthesia in high risk patients with ischemic heart disease undergoing major non-cardiac surgery is associated with less perioperative acute inflammatory response, less post-operative pain and can reduce the perioperative myocardial damage.