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Case Reports
. 2024 May 11;16(5):e60074.
doi: 10.7759/cureus.60074. eCollection 2024 May.

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

Amreesh Paul  1 , Amol Singam  1 , Nikhil Bhalerao  1 , Dnyanshree Wanjari  1 , Anjali Borkar  1
Affiliations
Case Reports

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

Amreesh Paul et al. Cureus. .

Abstract

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.

Keywords: breast cancer; cancer pain; cardiac dysfunction; cervical epidural anesthesia; modified radical mastectomy (mrm).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Electrocardiograph of the patient
Electrocardiography revealed left axis deviation, left ventricular hypertrophy with a strain pattern, and ST segment depression in the lateral leads.
Figure 2
Figure 2. Administration of CEA in situ
CEA, cervical epidural anesthesia
Figure 3
Figure 3. Intraoperative image
Stewart’s incision, a transverse elliptical incision, was used for the surgery.
Figure 4
Figure 4. Excised breast tissue
Breast tissue, including the pectoralis fascia, was meticulously separated from the pectoralis muscle and removed.
Figure 5
Figure 5. Image taken during wound closure showing the patient’s spontaneous breathing
See this image and copyright information in PMC

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