title: Cervical epidural anesthesia: a safe alternative to general anesthesia for patients undergoing cancer breast surgery.
abstract: BACKGROUND
  General anesthesia (GA) is the standard anesthesia for patients undergoing modified radical mastectomy (MRM) for breast cancer. Cervical epidural anesthesia (CEA) is practiced less often because of its reported complications. This prospective study aimed to evaluate the safety and efficacy of CEA as an anesthetic technique for MRM.
  
  
  METHODS
  Fifty breast cancer patients with ASA (American Society of Anesthesiologists) grade I or II underwent MRM under CEA from September 2004 to January 2006. Anesthesia was induced with 10 ml of 1% lignocaine; adrenaline was administered through an 18-gauge catheter in C(6)-C(7) or C(7)-T(1) epidural space. Postoperative analgesia was maintained with 0.125% bupivacaine through the epidural catheter.
  
  
  RESULTS
  In 49 (98%) patients surgery was conducted smoothly under CEA with good analgesia. 44 patients were awake during surgery. Five patients had to be given intravenous sedation with midazolam, and in one case the procedure was terminated after accidental dura puncture. There were no clinically significant variations in perioperative pulse and respiratory rate, and there was no fall in mean arterial blood pressure during the procedure. The mean preoperative anesthesia time and total cost of the procedure was 20.36 + 2.75 minutes and 12.19 + 2.2 pound, respectively. All patients were started on a liquid diet and mobilized 4 hours after surgery.
  
  
  CONCLUSIONS
  Cervical epidural anesthesia is a safe alternative to GA and was preferred by our patients because of its lower cost and reduced perioperative morbidity.
authors.affiliation: Department of Anaesthesiology, IMS, BHU, Varanasi, Uttar Pradesh, India.
authors.forename: A P
authors.initials: AP
authors.lastname: Singh
authors.forename: Mallika
authors.initials: M
authors.lastname: Tewari
authors.forename: D K
authors.initials: DK
authors.lastname: Singh
authors.forename: Hari S
authors.initials: HS
authors.lastname: Shukla
mesh_terms: D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D009333:Neck; D011446:Prospective Studies