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Thoracic epidural anesthesia for modified radical mastectomy in carcinoma of breast patient with chronic obstructive pulmonary disease: A case report
Balaji Narayan Asegaonkar1, Sujata Rahul Zine2, Unmesh Vidyadhar Takalkar3, Umesh Kulkarni4, Shilpa Balaji Asegaonkar5, Pushpa Kodlikeri6
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.

doi:10.5348/ijcri-2013-10-376-CR-5

Address correspondence to:
Dr. Balaji Narayan Asegaonkar
MD, D.N.B. Anesthesiology, C-13 Swarsangam Housing Society
New Shrey Nagar
Aurangabad, Maharashtra
India - 431005
Phone: 919325078733
Fax: 912402359279
Email: b_asegaonkar@yahoo.com

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How to cite this article:
Asegaonkar BN, Zine SR, Takalkar UV, Kulkarni U, Asegaonkar SB, Kodlikeri P. Thoracic epidural anesthesia for modified radical mastectomy in carcinoma of breast patient with chronic obstructive pulmonary disease: A case report. International Journal of Case Reports and Images 2013;4(5):546–550.


Abstract
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 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.

Keywords: Carcinoma of breast, Modified radical mastectomy, Thoracic epidural anesthesia, Chronic obstructive pulmonary disease (COPD)


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Author Contributions
Balaji Narayan Asegaonkar – Anesthetic management of the patient, Analysis and interpretation of data, drafting and critical revision of article and final approval of manuscript.
Sujata Rahul Zine – Anesthetic management of the patient, drafting and critical revision of article and final approval of manuscript.
Unmesh Vidyadhar Takalkar – Diagnosis and surgical Management of case, critical revision of article, final approval of manuscript.
Unmesh Kulkarni – surgical Management of case, critical revision of article, final approval of manuscript.
Shilpa Balaji Asegaonkar – Acquisition of data, Analysis and interpretation of data, drafting and critical revision of article and final approval of manuscript.
Pushpa Kodlikeri – Concerned with perioperative management of the patient, drafting and critical revision of article and final approval of manuscript.
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The corresponding author is the guarantor of submission.
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Conflict of interest
Authors declare no conflict of interest.
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© Balaji Narayan Asegaonkar et al. 2013; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)