Feasibility of Cervical Epidural Anesthesia for Breast Cancer Surgery

Cervical Epidural Anesthesia in the Management of a Patient With Breast Cancer With Cardiac Dysfunction: A Case Report

As one of the most common cancers in the world, breast cancer management is fraught with difficulties. Modified radical mastectomy (MRM) is one of the surgical procedures that is essential to the treatment of breast cancer. Cardiovascular issues, especially a reduced ejection fraction (EF), make these procedures more complex. Due to their increased vulnerability to adverse cardiac events during surgery, it is imperative to preserve hemodynamic stability and reduce physiological stress responses in these patients. A promising option in this changing field of anesthetic techniques is cervical epidural anesthesia (CEA). It effectively reduces hemodynamic fluctuations frequently linked to general anesthesia while providing analgesia. We report the case of an elderly patient with decreased EF and breast cancer scheduled for an MRM. To ensure the best possible outcomes in complex cases, the case report covers preoperative assessment, anesthesia technique, intraoperative management, and postoperative outcomes. This highlights the critical significance of customizing anesthesia and surgical procedures, informed consent, and meticulous postoperative pain management, and ultimately advocates for the broader implementation of CEA in such settings.

Thoracic Epidural Anesthesia for Modified Radical Mastectomy in a High-Risk Patient: A Case Report With Literature Review

Surgery is one of the mainstays of treatment in breast cancers. Typically, modified radical mastectomy (MRM) is done under general anesthesia (GA). However, GA is not a reasonable choice in patients with multiple comorbidities and difficult airways. Thoracic epidural anesthesia (TEA) is a reasonable and safe alternative to GA as it involves blunting of stress response and avoidance of airway handling apart from hemodynamic stability, lower analgesic consumption, superior postoperative analgesia, reduced postoperative nausea and vomiting, earlier resumption of feeding, and shorter duration of hospitalization. We report a case of advanced breast cancer in a 57-year-old female with a co-existing difficult airway, bronchial asthma, and hypertension in whom MRM was conducted successfully under TEA. We also present a comprehensive review of literature on the use of TEA for MRM.

Application effect of sevoflurane in the cesarean section of pregnant women with pernicious placenta previa and its influence on maternal hemodynamics

OBJECTIVE

To evaluate the application effect of sevoflurane in pregnant women with pernicious placenta previa who conduct the cesarean section and its influence on maternal hemodynamics.

METHODS

A total of 94 women with pernicious placenta previa (PPP) admitted to our hospital were recruited in this study. They were randomly divided into two groups, with 47 each group. The control group was given ketamine, propofol and rocuronium while the observation group was given sevoflurane base on conventional general anesthesia. The available data, intraoperative indexes, coagulation function before and after operation, hemodynamics, umbilical arterial partial pressure of oxygen and carbon dioxide before the procedure (T0), 5 min after anesthesia (T1), 15 min after anesthesia (T2) and during fetal delivery (T4) were observed. The Apgar scores of 1 min, 5 min and 10 min after birth were recorded.

RESULTS

No significant difference was seen in related indicators during operation and blood coagulation function before and after the operation between the two groups (P>0.05). The diastolic blood pressure and systolic blood pressure decreased at T1, T2 and T3 compared with T0 time (P<0.05). The decrease was more evident in the control group than in the observation group (P<0.001). The mean arterial pressure in the two groups at T1, T2 and T3 was higher than that at T0 (P<0.05). At T2, the increase in the control group was more obvious than that in the observation group (P<0.001). The heart rate at T1 and T2 was higher than that at T0 (P<0.05). Compared with the control group, the oxygen pressure increased and the carbon dioxide pressure decreased in the observation group (P<0.001). The Apgar score of the observation group was higher than that of the control group at 1 min and 5 min (P<0.001).

CONCLUSION

Sevoflurane can stabilize hemodynamics, improve neonatal oxygen uptake rate and increase the safety of operation without affecting coagulation function, which is worthy of clinical application.

Quality of postoperative recovery after upper-arm vascular surgery for hemodialysis in patients with end-stage renal disease: A prospective comparison of cervical epidural anesthesia vs general anesthesia

Cervical epidural anesthesia (CEA) is generally not used during upper-arm vascular surgery for hemodialysis in end-stage renal disease (ESRD) patients, despite its advantages. The Quality of Recovery-40 questionnaire (QOR-40) has been validated as a tool for assessing the degree of recovery after surgery. We hypothesized that CEA could provide a better outcome on the QOR-40 than general anesthesia after upper-arm vascular surgery for hemodialysis in ESRD patients.We divided anesthetic methods into general anesthesia and CEA. The QOR-40 was administered to 70 patients on the night before surgery and at 24 hours after surgery. Additional data, including consumption of opioid analgesics, occurrence of postoperative nausea and vomiting, and scores on a numeric rating scale (NRS) were collected.The total QOR-40 scores of the two groups differed significantly (P = .024) on postoperative day 1. Opioid consumption (P = .005) and occurrence of postoperative nausea (P = .019) in the post-anesthesia care unit (PACU) were significantly lower in the CEA group, whose NRS scores were significantly lower in the PACU (P < .001) and at postoperative day 1 (P = .016).Assessment of postoperative quality of recovery after upper-arm vascular surgery in ESRD patients showed that the CEA group had significantly better total QOR-40 and NRS scores. CEA could be used as an alternative anesthetic technique for upper-arm vascular surgery for hemodialysis in ESRD patients to improve the quality of recovery.