Thoracic epidural anesthesia for modified radical mastectomy in carcinoma of breast patient with chronic obstructive pulmonary disease: A case report

Introduction: Modified radical mastectomy, the standard surgical procedure in the management of carcinoma of breast is routinely performed under general anesthesia. but the patients of chronic obstructive pulmonary disease with other comorbidites are at increased risk of perioperative morbidity and mortality especially because of pulmonary complications. We report successful perioperative management of modified radical mastectomy only with thoracic epidural Balaji Narayan Asegaonkar1, Sujata Rahul Zine2, Unmesh Vidyadhar Takalkar3, Umesh Kulkarni4, Shilpa Balaji Asegaonkar5, Pushpa Kodlikeri6 Affiliations: 1MD, D.N.B. Anesthesiology, Consultant Anesthesiologist Kodlikeri Memorials CIIGMA Institute of Medical Sciences Aurangabad, Maharashtra, India; 2M.B.B.S.D.A.F.C.P.S. Anesthesiology, Consultant Anesthesiologist Kodlikeri Memorials CIIGMA Institute of Medical Sciences Aurangabad, Maharashtra, India; 3MS, Surgery M.E.D.S, F.U.I.C.C. (Switzerland), MSSAT (USA), Cancer, Consultant Surgeon Kodlikeri Memorials CIIGMA Institute of Medical Sciences Aurangabad, Maharashtra, India; 4M.D. Biochemistry, Asistant Professor, Department of Biochemistry Government Medical College Aurangabad Maharashtra, India; 5M.S. Surgery, Consultant Surgeon Kodlikeri memorials CIIGMA Institute of Medical Sciences Aurangabad, Maharashtra, India; 6M.B.B.S, MIFEE, MIAHR, Consultant Gynecologist Kodlikeri memorials CIIGMA Institute of Medical Sciences Aurangabad, Maharashtra, India. Corresponding Author: Dr. Balaji Narayan Asegaonkar, MD, D.N.B. Anesthesiology, C-13 Swarsangam Housing Society New Shrey Nagar, Aurangabad, Maharashtra, India 431005; Ph: 919325078733; Fax: 912402359279; E-mail: [email protected] Received: 11 February 2013 Accepted: 10 May 2013 Published: 01 October 2013 anesthesia in a diagnosed case of carcinoma of breast with hypertension, type 2 diabetes mellitus and severely compromised pulmonary function. case report: A 66-year-old female, a known case of chronic obstructive pulmonary disease since seven years with comorbidites (AsA grade III), presented with carcinoma of breast was scheduled for modified radical resection. continuous thoracic epidural anesthesia was administered at t4-5 level. Local anesthetic titrated as per the demands of surgery and postoperative analgesia. chromic obstructive pulmonary disease has been considered as independent risk factor for postoperative morbidity and mortality because of cardiopulmonary complications. but thoracic epidural anesthesia, one of the regional anesthesia techniques, with use of low dose of local anesthetic helps preserving respiratory function. the procedure was well tolerated without cardiopulmonary complications which lead to prompt recovery with additional effect of prolonged postoperative analgesia. conclusion: thoracic epidural anesthesia provided not only hemodynamic, cardiopulmonary stability but also adequate anesthesia, analgesia and satisfaction to patient in postoperative phase. It proved to be an excellent anesthesia technique for modified radical mastectomy in patient with chronic obstructive pulmonary disease.