மயக்க மருந்து & மருத்துவ ஆராய்ச்சி
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சுருக்கம்

Anesthetic Management Using Epidural Anesthesia Combined with UltrasoundGuided Serratus Plane Block for Breast Surgery of Two Patients with Severe Respiratory Disorder

Kozue Eda, Nanako Ogura, Teppei Yamada, Koichi Fujii, Shigeki Yamaguchi, Shinsuke Hamaguchi

Background: Regional anesthesia is recommended for the anesthetic management of patients with low respiratory function undergoing mastectomy. We present two cases of breast surgery under thoracic epidural anesthesia in combination with ultrasound-guided serratus plane block (SPB) and intravenous sedation. General anesthesia was considered difficult to induce in these patients because of their underlying respiratory condition.

Case presentation: Patient 1 was a 40-year-oldfemalewho underwent a partial phyllodes tumor resection. She had muscular dystrophy, diabetes mellitus, and allergic reaction to non-steroidal anti-inflammatory drugs and acetaminophen. We combined epidural anesthesia with SPB and inhalation of nitrous oxide and 0.5%-1.0% sevoflurane via a face mask under spontaneous breathing. Patient 2 was a 66-year-old woman who underwent an early breast cancer resection. She had severe bronchial asthma, hypertension, and glaucoma. Because the patient had chronic obstructive disorder (COPD) due to asthma, we performed a combination of thoracic epidural block and ultrasound-guided SPB under sedation by sevoflurane inhalation. No adverse event occurred intra operatively in both cases.

Conclusion: A combination of thoracic epidural anesthesia and SPB under inhalation of low-concentration sevoflurane was useful for peri-operative anesthetic management in patients with severe respiratory dysfunction. This could be an option for the management of anesthesia in patients with low respiratory function undergoing mastectomy.