Epidural for high-dose radiation brachytherapy in a noncompliant, super-obese patient with severe pulmonary hypertension

Abstract

High-dose radiation brachytherapy is a treatment for inoperable cervical and endometrial carcinoma. A general anesthetic is often utilized for patient comfort, facilitating patient transport to imaging resources, and allowing rapid discharge home after the procedure. Patient comorbidities, however, must be considered for every anesthetic performed. We describe a successful surgical epidural anesthetic for a patient with challenging comorbidities, including cardiac, pulmonary, and hematologic body systems.

Unique considerations in regional anesthesia for emergency department and non-or procedures

“…103,104 The benefits of regional anesthesia can even be extended to brachytherapy procedures, which can be either managed with a lumbar epidural as the primary means of anesthesia or as a pathway for the provision of postprocedural analgesia. 105,106 Outside of these traditional NORA locations, the cardiac ICU and psychiatry units may represent opportunities to provide stellate ganglion blocks as a mechanism to terminate aberrant arrhythmias or reduce the severity of posttraumatic stress disorder symptoms. 107 In many cases, identifying opportunities for regional anesthesia procedures outside of the operating room requires expanding the scope of potential medical professional collaborators.…”

“…The use of paravertebral or erector spinae plane blocks to alleviate the pain associated with this procedure has been associated with improved patient satisfaction scores, lower opioid requirements, and a decreased requirement for antiemetics 103,104 . The benefits of regional anesthesia can even be extended to brachytherapy procedures, which can be either managed with a lumbar epidural as the primary means of anesthesia or as a pathway for the provision of postprocedural analgesia 105,106 …”