49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Same Day Breast Surgery Under Thoracic Epidural

Sejal J. Shah, M.D., Shubha Srinivasareddy, M.D., Justin Walker, M.D.

Introduction

- Breast surgery is usually performed under general anesthesia

- Patients with multiple comorbidities could be at high risk of complications with general anesthesia

- Thoracic epidurals offer an alternative method of anesthesia for high-risk patient during breast surgeries

Case Report

- 72-year-old female with breast cancer and history of LAD ischemia requiring future intervention presents for bilateral partial mastectomies

- History of two prior laryngospasms with intubation, one leading to negative pressure pulmonary edema requiring prolonged intubation

- Perioperative anesthesia clinic: patient requested avoiding any manipulation of airway

- Informed consent on day of surgery discussed risks and benefits of thoracic epidural, as well as the potential to convert to general anesthesia

- Preformed a T7-8 epidural on day of surgery with moderate IV sedation intraoperatively

- Mean arterial pressure was maintained within 20% of patient's baseline pressures

- Avoided general anesthesia and opioid administration

- Discharged home the same day

Discussion

- Thoracic epidurals are a viable alternative to general anesthesia in patients with respiratory or cardiac comorbidities

- Thoracic epidurals offers hemodynamic stability and improved myocardial oxygen balance

- Anticoagulation status needs to be discussed with patient and operative team prior to surgery

- This method can also reduce cost of hospitalization by decreasing length of stay as well as reductions in medication administration

SAME DAY BREAST SURGERY UNDER THORACIC EPIDURAL