Open Access Research Article Anesthesia & Clinical Research Mohamed et al., J Anesthe Clinic Res 2013, 4:3 http://dx.doi.org/10.4172/2155-6148.1000296 Volume 4 • Issue 3 • 1000296 J Anesth Clin Res ISSN:2155-6148 JACR an open access journal Introduction Despite major advances in peri-operative management techniques, Myocardial Infarction (MI) remain the most common cause of postoperative morbidity and mortality in patient undergoing non- cardiac surgery [1]. Patients experiencing MI in the peri-operative period have a hospital mortality of 15%-25% [2-5]. he high mortality rate could be due to diiculty in detecting peri-operative MI because typical Electrocardiographic (ECG) changes and classical clinical symptoms are oten absent [6]. As a growing number of elderly patients at risk of cardiac diseases are undergoing surgery, management of such complication will remain a signiicant clinical and economical challenge in the future. he diagnosis of MI traditionally relies on rise and fall of cardiac enzymes such as Creatinine Kinase (CK), creatine kinase muscle and brain isoenzyme (CK-MB), Troponin I and T. With evidence of ischemia [clinical symptoms such as chest pain, supportive electrocardiographic changes] [3]. Troponin is more sensitive and speciic, and correlate more closely with the amount of cardiac damage that occurs than CK- MB and is the favoured cardiac enzyme for testing. Troponin T has been found to have a higher positive and negative predictive values, sensitivity and speciicity than either troponin I or CK-MB [7]. A rise in troponin T is not normally associated with musculoskeletal trauma [7,8]. Troponin levels begin to rise 4-6 h ater the onset of symptoms, similar to CK-MB. Peak values occur 18-24 h ater the onset of symptoms. Serum troponin persists for 7-14 days due to its slow release and degradation which allows for increased detection time window of cardiac events [9]. However, cardiac ischemia can be diicult to recognize in the post- operative period because of their silent nature and electrocardiograph changes may be hard to detect, oten being non-q wave in origin. However, given there is no current consensus about what deines an infraction in the post-operative setting, perhaps all that can be deduced is that an elevation in troponin, for example, might indicate myocardial injury and provide prognostic information [3]. C-reactive protein (CRP) is a protein found in the blood, the levels of which rise in response to inlammation (an acute phase reactant protein). Its physiological role is to bind to phosphocholine expressed on the surface of dead or dying cells (and some type of bacteria) in order to activate the complement system via C1Q complex to facilitate their destruction by the phagocytes [10]. *Corresponding author: Sahar A. Mohamed, Anesthesiology Department, Intensive care, and pain management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt, Tel: 002- 010-03611410; E-mail: drsaher2008@yahoo.com Received February 06, 2013; Accepted March 14, 2013; Published 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 Inlammatory 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. The Effect of Anesthetic Technique on Cardiac Troponin-T and Systemic Inflammatory Response after Major Abdominal Cancer Surgery Sahar A Mohamed 1 *, Khaled M Fares 1 , Hosam Hasan-Ali 2 and Rania Bakry 3 1 Anesthesiology Department, South Egypt Cancer Institute Assiut University, Egypt 2 Cardiology Department, Faculty of Medicine, Assiut University, Egypt 3 Clinical pathology Department, South Egypt Cancer Institute Assiut University, Egypt Abstract Objectives: this study aims at assessment of acute inlammatory 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 irst request of rescue analgesic, analgesic consumption, hemodynamics and side effects were recorded in irst 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 signiicantly reduced in G2 allover time in comparison to G1 (p<0.05) except at 32hrs postoperatively. Mean time to irst request for rescue analgesic was signiicantly prolonged in G2 compared to G1 (p=0.001). Mean morphine consumption was signiicantly reduced in G2 (p<0.001). Mean serum level of CPR increased in both groups. Mean level of serum troponin-T was signiicantly increased only in G1 compared to baseline value (p<0.05) with no signiicant 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 inlammatory response, less post-operative pain and can reduce the perioperative myocardial damage.