الفهرس 
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Abstract
This controlled study was carried out on forty elderly patients of either sex with age above 64 years, they were submitted for major abdominal or pelvic surgery.
They were allocated through a controlled blind study into 4 groups; each comprised of 10 patients .All groups received general anaesthesia. Patients in groups (II, III, IV) received epidural analgesia via an epidural catheter as a bolus injection before induction of general anaesthesia .The epidural mixture in all groups contained 25 mg of 0.125% bupivacaine which was combined with 2mg morphine in group II, While in group III it was combined with 40 mg ketamine and in group IV it was combined with 1 mg morphine+20 mg ketamine. Patients in group I received 0.05-0.1mg/kg iv morphine before induction of general anaesthesia. Anaesthesia was induced with a sleeping dose of thiopentone and tracheal intubation was facilitated with suxamethonium. Anaesthesia was maintained by isoflurane 0.2%-2% carried by 60% nitrous oxide in oxygen with controlled ventilation.
The patients were monitored through 3 lead ECG, pulse oximeter, capnography in addition to the invasive haemodynamic monitoring via a pulmonary artery catheter. Haemodynamic and oxygenation variables were continuously monitored and recorded at certain time intervals as follows: basal, 30 min after epidural, 5 min after induction, at skin incision, 30 min after induction, 1 hr, 2hr, 3hr(intraoperatively), at time of closure of the wound and postoperatively in surgical ICU at 1hr, 6 hr and 24 hr.
Monitoring of the patients was extended in the surgical ICU postoperatively regarding haemodynamics, breathing pattern and oxygenation. Also, the degree of sedation and analgesia was assessed, Accordingly, analgesic drugs were administered in the form of top up doses of epidural drugs.
Conclusions
From this study, it could be concluded that the use of epidural ketamine provides better haemodynamic stability than epidural morphine. However; the negative inotropic effect of epidural ketamine was more evident than epidural morphine. The combination of epidural ketamine with morphine was found to provide good haemodynamic stability with no negative inotropicity and with a longer duration of analgesia than epidural ketamine.