الفهرس 
Acknowledgement
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Abstract
Fast track anaesthesia is a recent strategy in cardiac surgery. Using new methods to achieve rapid recovery, good analgesia and myocardia protection to allow early extubation and decrease ICU and hospital stay. Dexmedetomedine is α2- agonist has sedative, analgesic and sympatholytic properties, decrease sympathetic tone and neuroendocrine response to stress. So reduced anaesthetic and opioid requirement. This study aim to evaluate the different route of dexmedetomedine administration (intravenous, thoracic epidural) as regard myocardial protection and post-operative analgesia. Sixty patients divided into 3 groups 20 patients in each group : group (A): [intravenous dexmedetomedine infusion (IV Dex)]: Patients in IV dex group will receive dex 0.5 μg /kg /h for 20 minutes before induction of anesthesia and 0.4 μg / kg / h thereafter then reduced to 0.2 μg / kg /h at ICU arrival , this will continue till patient extubation . group (B): [thoracic epidural dexmedetomedine (TE Dex)]: Patients in TE dex will receive 1μg/kg/ in 20ml normal saline in 20 min via thoracic epidural catheter before induction of anesthesia, 1 hour later and after induction of anesthesia the maintenance dose will reduce to 0.2 μg / kg / h via thoracic epidural catheter till end of surgery and will continued in ICU till patient extubation . group (c): [Control, in which patients will not receive Dex]: Patients in this group did not receive intravenous dexmedetomedine or thoracic epidural infusion dexmedetomedine during this study. All patients were subjected to the same anesthetic management as regard to drugs used, monitoring, and the management of cardiopulmonary bypass. Postoperative monitoring includes heart rate, rhythm, mean systemic arterial pressure, central venous pressure, arterial blood gas analysis, serum level of electrolyte (sodium, potassium), Troponin I, the inotropic score (VAIS) and duration of both mechanical ventilation and ICU stay and also numerical rating pain score (NRPS), analgesia profile. In our study, there was no significant difference between three groups regarding demographic data, diagnosis and type of surgeries, preoperative ECG. The MV time, ICU stay and hospital stay showed that both epidural and IV groups had significantly lower in comparison to the control group with no difference between epidural and IV groups. The mean blood pressure showed no significant difference between the studied groups with exception of significantly higher MBP in post- induction periods and on MV in IV group in comparison to other groups. HR showed no significant difference between the studies groups with exception of significantly lower at time of induction, post- induction, and post- bypass, time of ICU admission, and after MV in epidural and IV groups in comparison to control group. There was no significant difference between the studies groups in the mean VAIS over 24 hours. NRPS at different time of assessment was significant lowered among IV and epidural groups in comparison to the control group with no significant difference between the epidural and IV group. We founded that first dose required of analgesia in IV group and epidural group was longer in duration in comparison to control group. Also total dose of perfalgan and morphine was significant higher among the control group in comparison to other groups. There was no significant difference in arterial blood gas between the different groups, also no significant difference in the serum level of sodium and potassium between the different groups. No significant difference in troponin I level between different groups preoperative but there were significantly lower 48 h – after weaning and 72h- after weaning among IV group and epidural group in comparison to the control group. Conclusion: Both intravenous infusion of dexmedetomedine or thoracic epidural infusion are effective in fast track anaesthesia, also both route of infusion could decrease ICU stay and hospital stay. Both routs of infusion have excellent effect in decrease pain and analgesia requirement. Both route of infusion offer a accepted intraoperative and postoperative hemodynamic stability and offer a good myocardial protection.