The Impact of Left Stellate Ganglion Block on Systemic Inflammation and Neuromodulation in CABG Surgery.

((82)) patients scheduled to undergo elective CABG by the same surgical team will be allocated randomly by computer-generated random numbers into two equal groups (n= 41). Study groups: Group S (Stellate Ganglion Block Group): Patients will receive an ultrasound-guided Left stellate ganglion block prior to induction of general anesthesia. The block will be performed at the C6 level under strict aseptic precautions using 5 mL of 0.25% bupivacaine. Successful blockade will be confirmed by the appearance of ipsilateral Horner's syndrome. Group C (Control Group): Patients will receive standard perioperative care without stellate ganglion block and will undergo the same anesthetic and surgical management protocol as Group S.

Inclusion Criteria: 1. All elderly (≥65 years) patients of both genders, as according to the World Health Organization, the chronologic age of 65 years was accepted by most developed countries in the world as a definition of "elderly" or older person. Patients scheduled for elective cardiac surgery under general anesthesia.14 2. American Society of Anesthesiologists (ASA) physical status class II or III. 3. Patients will be stratified according to their baseline surgical risk utilizing the EuroSCORE II tool \>4%15. 4. American Society of Anesthesiologists (ASA) physical status class II or III. Exclusion Criteria: 1. Pre-existing dementia or significant cognitive impairment. 2. History of stroke or cerebrovascular disease. 3. Contraindications to SGB (e.g., coagulopathy, local infection, or anatomical abnormalities). 4. Preoperative use of antipsychotics or antidepressants. 5. Sinus bradycardia \35 7. Redo or emergency surgery. 8. On preoperative mechanical ventilation and long sedation time. 9. Low EF patients \