Clinical Research Directory

Inclusion Criteria: * Age from 18 to 75 years old. * Both genders. * American Society of Anesthesiologists (ASA) physical status classification II or III. * Scheduled for thoracotomy. Exclusion Criteria: * Difficult airway management, * Hemodynamically unstable patients, obesity (body mass index \>30). * Absolute contraindication to thoracic epidural anesthesia such as (patient refusal, allergy to local anesthetics, coagulopathy, active neurologic disorders, skin infection at insertion site, uncooperative patients, uncontrolled cough, and unfavorable anatomy for thoracic epidural). * Neurological disorders: risk of seizure, unable to cooperate, intracranial mass or brain edema, extensive pleural adhesions or previous pulmonary resections, hypoxemia (PaO2 \<60) or hypercarbia (PaCO2 \>50) * Poor cardiac function (ejection fraction less than 50%). * Patients with bad pulmonary function tests.