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CASE REPORT
Year : 2019  |  Volume : 16  |  Issue : 2  |  Page : 97-99

Cervical epidural anesthesia for radical mastectomy in an elderly patient with severe respiratory compromise


1 Department of Anaesthesia and Critical Care, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India
2 Department of Surgical Oncology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India

Correspondence Address:
Vikas Gogia
House No. 782, Sector 28, Faridabad - 121 008, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_6_18

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Cervical epidural anesthesia for breast surgery has been described in a few trials on patients with good physical status. This case report describes the successful use of cervical epidural anesthesia in a patient with severe respiratory compromise without any complication. A 72-year-old female patient having infiltrating duct carcinoma of the right breast with coexisting chronic obstructive airway disease and bronchial asthma was planned for modified radical mastectomy with axillary clearance. Her forced vital capacity (VC) was 28% predicted with reversibility of 24% and forced expiratory volume in 1 s was 31% predicted with 35% reversibility. After discussion with the surgical team, a regional anesthetic was planned for the patient and a cervical epidural catheter placed at C7–T1 interspace was used to provide adequate dermatomal anesthesia for the surgery. Dexmedetomidine was used to achieve sedation for patient comfort with minimal respiratory depression. The SpO2 and end-tidal CO2 recordings remained stable throughout the procedure, with excellent intra- and postoperative analgesia. Despite the concerns of bilateral phrenic nerve palsy with the use of cervical epidural anesthesia and associated decrease in VC, a carefully conducted cervical epidural anesthesia can be used for patients with respiratory compromise undergoing major breast surgery. Radical mastectomy, cervical epidural anesthesia, low FEV1, FVC, dexmedetomidine.


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