الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Introduction: As the population ages there will be an ever-increasing number of elderly patients who will require surgical care. Currently patients aged 65 and above comprise at least one quarter of the surgical population. Elderly patients are the most challenging group of patients to safely manage during anaesthesia, and this largely relates to changes in their physiology with advancing age. Elderly patients are at particular risk for coronary artery disease. Therefore, they stand to benefit the most from strategies to prevent perioperative cardiac events. Post-operative cardiac ischaemic injury is a significant concern in elderly patients undergoing non-cardiac surgery. The diagnosis of myocardial infarction is challenging during the post-operative period. First, ECGchanges are not always present and can be difficult to interpret when there are background abnormalities. Secondly, analgesics and hypnotics may blunt cardiac pain perception and cognitively impaired patients may not be able to effectively communicate their symptoms. Therefore, there may be more reliance on biochemical markers during the post-operative period Troponin I has emerged as the biomarker of choice for the detection of myocardial injury, being a more sensitive and specific marker compared to CK and CK-MB. A protective myocardial effect of sevoflurane and propofol was documented in several animal studies and clinical investigations in patients with coronary artery bypass grafting (CABG). Aim of Work: This study was designed to examine whether sevoflurane or propofol anesthesia has cardioprotective properties in elderly patients undergoing cataract surgery. These cardioprotective effects were examined through observation of the following variables: (1) Hemodynamic changes including: heart rate (HR), mean arterial pressure (MAP), and rate pressure product (RPP). (2) ECG changes including ST-T wave changes or new Q waves. (3) Cardiac biomarkers assay including creatinekinase-myocardial band variant (CK-MB) and Troponin I Patients & Methods: Our study was performed on 60 elderly patients > 65 years,ASA II-III physical status, 30 diabetic patients (insulin or non insulin dependent) and 30 non diabetic patients as control group. These patients were scheduled for cataract surgery under general anesthesia either by sevoflurane inhalational anesthesia or propofol TIVA assigning the patients into 4 groups : group- CS (control sevoflurane), group- CP (control propofol), group- DS (diabetic sevoflurane), group-DP (diabetic propofol). After statistical analysis of data and results of patients’ monitoring and cardiac markers assay and by comparison of the 4 groups, there was insignificant release of myocardial markers of injury in the postoperative period as compred to preoperative basal values. Only CKMB showed insignificant rise at 6 hour postoperative which returned to basal value at 24 hours. Results: There were significant reduction in heart rate in sevoflurane groups compared with propofol groups whereas mean arterial pressure and rate pressure product showed significant increase in sevoflurane groups mainly due to changes in systolic blood pressure. No severe events occurred during anesthesia and surgery, and no signs of ischemia or myocardial infarction were observed on the ECG during the procedure and all patients were discharged the next day. Conclusion: We have demonstrated that sevoflurane compares favourably with propofol regarding hemodynamic stability and myocardial protection in the form of insignificant release of Troponin I and CKMB in elderly patients undergoing cataract surgery. Due to lack of studies in which volatile anesthetics were compared with total intravenous anesthesia regarding postoperative mortality or cardiac complications after noncardiac surgery, we recommend further studies in high risk surgery including vascular or major abdominal surgery.