Cervical epidural anaesthesia for breast surgery has been described in a few trials on patients with good physical status. The real benefits of changing the routine general anesthetic approach to a regional one have not been reported in patients with decreased respiratory reserve. This case report describes the successful use of cervical epidural anaesthesia in a patient with severe respiratory compromise. A 72 years female patient having carcinoma of the right breast with coexisting severe Chronic Obstructive Airway Disease (COAD) was planned for Modified Radical Mastectomy with axillary clearance. After discussion with surgical team, a cervical epidural anaesthetic was planned to provide adequate dermatomal anaesthesia for the surgery. Patient was given dexmedetomidine for sedation during surgery. Despite the concerns of bilateral phrenic nerve palsy and associated decrease in vital capacity, a carefully conducted cervical epidural anaesthesia can be used for patients with respiratory compromise undergoing major breast surgery.
Key Words: mastectomy, epidural anaesthesia, dexmedetomidine.
Key message: Cervical epidural Anaesthesia is a safe and useful tool for patients with severe respiratory disease undergoing extensive breast surgery and offers significant advantage over general anaesthesia.
Introduction
The traditional anesthetic approach for radical breast surgery has been general anaesthesia. Various studies and case reports have described use of regional techniques for either postoperative analgesia or as the sole anesthetic technique for this surgery. Cervical epidural anaesthesia is the most likely to obviate the need for general anesthetic supplementation as it can achieve a dermatomal spread from C3-T8 allowing axi...
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...Inspiratory vital capacity (IVC), vital capacity (VC), FVC, FEV1 and PEFR were found decreased by 18% at 20 min and 12% at 50 min and FEV1: FVC ratio was maintained within normal limits. We gave the local anesthetic in small aliquots titrating to the desired level of block and didn’t encounter any significant reduction in respirator excursions; respiratory rate was only slightly increased from 18 to 22.
Dexmedetomidine has been used for providing conscious sedation. Paris A, Tonner PH [6] in their drug review concluded that Dexmedetomidine provides dose-dependent sedation, analgesia, sympatholysis and anxiolysis without relevant respiratory depression.
Conclusion
Cervical epidural anaesthesia, when employed carefully can be useful in patients with preoperative respiratory compromise. It may improve postoperative outcome with reduction in respiratory complications.
This essay describes how the anaesthetic machine and airway management equipment are prepared in operating theatres and discusses how they are ensured safe for use. It evaluates the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines related to safe practice and the preparation of the ET tubes, laryngeal masks, guedels, Naso pharyngeal airways and the laryngoscope. The function of the anaesthetic workstation is to deliver a mixture of anaesthetic agents and gases safely to the patient during the induction process and throughout surgery. In addition, it also provides ventilation to support breathing and monitors the patient’s vital signs to minimise the anaesthetic risks to the patient whilst in the care of health professionals. The pre-use check is vital to patient safety as an inadequate check of the anaesthetic machine or airway management equipment can and does lead to significant harm of the patient including mortality (Medicines and Healthcare Products Regulatory Agency (MHRA), 2008 and Magee, 2012).
In order to be completely informed a mother needs to know what exactly an epidural is and how it works. An epidural is the most popular form of pain relief during labor. An epidural is a regional pain reducer. An epidural is analgesia, which is meant for pain relief. This is much different than an anesthesia, which provides total lack of feeling to a region of the body. Epidurals are giving intravenously. There are two types of epidurals a woman can get. The first method is a regular epidural. In a regular epidural, after the catheter is in place, a combination of narcotic and anesthesia is administered either by a pump or by periodic injections into the epidural space. The second type of epidural is a combined spinal-epidural, these are often called the “”walking epidural”. In this type of epidural, an initial dose of narcotic, anesthetic or a combination of the two is injected beneath the outermost membrane covering the spinal cord.
Lindley, P., Pestano, C. R., & Gargiulo, K. (2009). Comparison of postoperative pain management using two patient-controlled analgesia methods: Nursing perspective. Journal of Advanced Nursing, 65(7), 1370-1380. doi: 10.1111/j.1365-2648.2009.04991.x
Nitrous oxide is administered via a face mask and is used to take the edge off of your nerves. This form of sedation is great for uncomplicated procedures and for patients experiencing only mild levels of fear or anxiety. If you fall into this category, nitrous oxide sedation may be for you.
Breathing is the most important AL (Roper et al, 1998). A detailed assessment of her airway would be performed because protection of the airway throughout anaesthesia is essential (Yates, 2000). This does not just include recording of respiration rate and oxygen saturation (SpO2) but also noting any use of accessory muscles, shortness of breath, auscultation of chest and lungs areas for wheezes/crackles and asking patient about history of any respiratory illness/smoking (McArthur-Rouse, 2007).
American Association of Nurse Anesthetists. Professional Aspects of Nurse Anesthesia Practice. Philadelphia: F. A. Davis Company, 1994. Print.
Anaesthetics included Midazolam, fentanyl, propofol, rocuronium and she also had a dose of cefazolin and gentamicin intra-operatively. She required some ephadrine and aramine intra-operatively but remained relatively normotensive? throughout the procedure.
Montgomery, G. H., Boybierg, D. H., Schnur, J. B., David, D., Weltz, A., & Schechter, C. R. (2007). A Randomized Clinical Trial of a Brief Hypnosis Intervention Control Side Effects in Breast Surgery Patients. Natl Cancer Inst, 99, 1304-1312.
After a laryngeal mask airway was inserted, sevoflurane was discontinued and anesthesia was maintained using desflurane. The initial desflurane concentration was randomly assigned and ranged between 4.5 and 7.5 end-tidal volume %. Following an equilibration period of 45 minutes, noxious electrical stimulation testing began. Intradermal needles inserted bilaterally into the anterior thighs were used to deliver electrical stimulation for 10 seconds at a time at an intensity of 100 Hz, 60-70 mA. This level of stimulation is not tolerated by unanesthetized patients, but is undetected by those under general anesthesia. Response to the stimulation was evaluated by an independent investigator who was chosen randomly out of a group of four investigators for each session. Investigators were brought into the room just before the stimulation commenced. A response was considered positive if a gross purposeful movement of the arms or legs occurred within the first minute after stimulation. While the investigators were not blinded to the hair color or skin complexion of the volunteers, they were blinded to both the initial desflurane concentration as well as the desflurane concentrations for the duration of the study. Depending on if the volunteer moved or did not move in response to the electrical stimulation, desflurane was increased or decreased by 0.5
End tidal carbon dioxide (ETCO2) monitoring is the non‐invasive measurement of exhaled CO2. ETCO2 monitoring is one of the objective standards set in the Intensive Care Society guidelines 2002 for the transport of the critically ill adult, and is mandated by the American Heart Association in the new pediatric advanced life support guidelines, which state that all intubations must be confirmed by some form of ETCO2 measurement. It can be concluded that the use of capnography monitoring on ALL patients who receive PCA can reduce the incidence of adverse events from IV opioids in the postoperative setting.
Describe how the client was monitored by the anesthesiologist or nurse anesthetist during the procedure. Include what type of anesthesia the client received and how the airway was maintained and monitored.
Firstly, Anesthesia made many surgical operations possible and saved millions of lives. As most people would have rather committed suicide than undergo surgery, Anesthetics allowed for patient’s to be operated on safely and without pain. Surgery is a very common practice in all parts of the world and can only be possible with the help of Anesthetics. According to the Massachusetts Academy of Mathematics and Science, ‘40 million people in North America are administered to Anesthesia every year’ (2010 p. 37). This statistic shows how Anesthesia influences many people lives every day.
Stomberg, M., Sjöström, B., & Haljamäe, H. (2003). The Role of the Nurse Anesthetist in the Planning of Postoperative Pain Management. AANA Journal, 71(3), 197.
The delivery of anesthesia to surgical patients is safer today than ever before. Advancements in technology such as end tidal carbon dioxide monitoring, oxygen saturation monitoring, video laryngoscopy and safer medication profiles are just a few examples in the realm of anesthesia that assist in protecting patients from potential harm. As the face of healthcare payments change into a patient-satisfaction and outcomes-driven model, it is important for the specialty of anesthesia to continue to find ways to keep patients safer by examining current accepted practices in anesthesia and challenging and changing practices that continue to place patients at risk for harm.
Anesthesia is used in almost every single surgery. It is a numbing medicine that numbs the nerves and makes the body go unconscious. You can’t feel anything or move while under the sedative and are often delusional after being taken off of the anesthetic. Believe it or not, about roughly two hundred years ago doctors didn’t use anesthesia during surgery. It was rarely ever practiced. Patients could feel everything and were physically held down while being operated on. 2It wasn’t until 1846 that a dentist first used an anesthetic on a patient going into surgery and the practice spread and became popular (Anesthesia). To this day, advancements are still being made in anesthesiology. 7The more scientists learn about molecules and anesthetic side effects, the better ability to design agents that are more targeted, more effective and safer, with fewer side effects for the patients (Anesthesia). Technological advancements will make it easier to read vital life signs in a person and help better decide the specific dosages a person needs.