DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20200730

Thoracic epidural for modified radical mastectomy in an asthmatic patient

Aarif A. A. R. Rangrez, Chetan Gopal Agrawal, Dattatraya Gangurde

Abstract


Thoracic epidural anaesthesia is one of the safe and good alternative to general anaesthesia in high risk patients of chronic obstructive pulmonary disease and asthma where general anaesthesia is contraindicated. A 55 years old female patient was scheduled for modified radical mastectomy on account of advanced carcinoma of right breast. The patient was known case of bronchial asthma since 5 years with frequent attacks per week for which she was taking nebulisation with salbutamol and budesonide two times per day. In the pre-operative evaluation, her vitals were within normal limit but on auscultation air entry was reduced all over the chest with bilateral crepts and rhochi present. We did this patient in plaine thoracic epidural anaesthesia without haemodynamic instability. Thoracic epidural anaesthesia and analgesia for mastectomy is feasible, and it offers additional benefits in high-risk patients.


Keywords


Thoracic epidural, Modified radical mastectomy, Asthma

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References


Etta OE, Udeme N. Thoracic epidural for modified radical mastectomy in a high-risk patient. Malawi Med J. 2017;29(1):61-2.

Balzarena SD. Comparative study between thoracic epidural block and general anaesthessia for oncologic mastectomy. Rev Bras Anestesiol. 2008;58(6):561-8.

Lynch EP, Welch KJ, Carabuena JM, Eberlein TJ. Thoracic epidural anaesthesia improves outcome after breast surgery. Ann Surg. 1995;222(5):663-9.

Asegaonkar BN, Zine SR, Takalkar UV, Kulkarni U, Asegaonkar SB, kodlikeri P. Thoracic epidural anaesthesia for modified radical mastectomy in carcinoma of breast patient with chronic obstructive pulmonary disease: A case report. Int J Case Reports Images. 2013;4(5):546-50.

Etta OE, Umeh K, Akpan SG. Thoracic epidural anaesthesia for major abdominal surgeries: experience in private hospital setting in Uyo, South-South Nigeria. SAJAA. 2016;22(3):86-8.

Tanaka K, Watanabe R, Harada T, Dan K. Extensive application of epidural anaesthesia and analgesic in a university hospital: Incidence of complications related to technique. Reg Anesth. 1993;18(1):34-8.

Howel SJ, Sear YM, Yeates D, Goldacre M, Sear JW, et al. Risk factors for cardiovascular death after elective surgery under general anaesthesia. Br J Anaesth. 1998;80:14-9.

Vishwanath RH. Thoracic Epidural anaesthesia for modified radical mastectomy in type 2 Diabetes mellitus patient. J Med Dent Sci. 2014;3(70):15002-6.

Rehman HU, Mohammed K. Perioperative management of diabetic patients. Curr Surg. 2003;60:607-11.

Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978-82.

Mizock BA. Blood glucose management during critical illness. Rev Endocr Metab Disorder. 2003;4:187-94.

Tang HJ, Lin HJ, Liu YC, Li CM. Spinal epidural abscess-experience with 46 patientsand evaluation of prognostic factors. J Infect. 2002;45(2):76-81.

Reihsaus G, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000;23(4):175-204.

Etta OE, Edubio MN. Awake thoracic epidural anaesthesia for laparotomy: A safer alternative to general anaesthesia in asthmatic patients. Ibom Medical journal. 2014;7(2):6-10.

Shono S, Higa K, Katori K, Nitahara K, Hamada T, Kusumoto G, et al. Tracheal Intubation does not Provoke Bronchospasm in Patients with Bronchial Asthma under Thoracic Epidural Anesthesia. Med Bull Fakuoka Univ. 2008;35:51-156.