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Anaesthetic Care Post Mastectomy

The aim of this essay is to discuss, analyse and evaluate the anaesthetic care delivered to a female patient who underwent right mastectomy under general anaesthesia. For confidentiality purposes I refer to my patient as Jane .Saunders (2016) points out that confidentiality is a moral obligation to the patient and it continues even after the patient’s death and any disclosure of information requires special justification. Jane is a forty year old lady who is normally fit and well. Her previous medical history included tonsillectomy as a child. She had recently experienced some changes in her right breast and had undergone a right breast biopsy, to be diagnosed a tumour, which needed surgical intervention. Breast cancer is the second most frequent malignant neoplasm worldwide (Gómez-Hernández et al 2010). LeeJiHeui et al (2016) arguesthat several factors during the perioperative period can lead to deterioration of the patient’s immune system, thereby promoting metastasis. Therefore optimum perioperative management is vital in ensuring a better prognosis for breast cancer patients.

Prior to the procedure, Jane was asked to attend a pre anaesthetic assessment where Jane was seen by the Anaesthetist. General anaesthesia, areversible drug-induced loss of consciousness (Franks 2006) was deemed suitable for Jane according to the anaesthetist as other anaesthetic techniques such as local and regional anaesthesia did not offer optimum results. According to Radford (2011) it is the foundation for creating a plan of care which would reduce the chances of suboptimal management thus increasing patient journey safe and effective throughout the procedure. The history of the patient  which consists of patient’s general health, medical and surgical history, social history which includes recreational activities, psychological and emotional issues plays a vital role in clinical decision making. Gray (2015) supports this.Alves et al 2010 argues that the usual pre-operative emotion in mastectomy patients is anxiety, initially considering the surgery as the potential cure and hope that, after it’sdone, they are safe from cancer. On the other hand they worry about the anaesthesia and possibility of facing a body that will no longer be the same. Hence multidisciplinary approach was necessary to support the patient so that the breast removal represents a moment of less shock, emotional commotion, depression and feeling of uselessness. Jane was no different to this and was quite anxious but was given enough information and support .Jane had previous general anaesthetic with no complications. Janestated she had no allergies and there wasno family history of anaesthetic complications.

The anaesthetist determines the classification of patient according to the physical status using the American Society of Anaesthesiologists (ASA 2014) grading system. The ASA grading system is widely used by anaesthetists in which the patients are classified according to their health condition. Class 1 indicates a normal healthy patient and Class 6 being brain dead (Cullen et al 2013). Jane was a class one patient as she was a normal healthy patient

Jane underwent a physical examination including airway assessment which included modified Mallampatti scoring and upper lip bite test .Evidence within the literature by Allman (2015) suggests that a primary cause of anaesthesia related mortality and morbidity is a difficult airway and inadequate management of the airway contributes to about thirty percentages of deaths attributable to anaesthesia .Rajesh MC et al (2015) argues that airway assessment together with adequate training and experience, and availability of essential equipment are the pillars of successful airway management. Even though widely used airway assessment tools such as inter-incisor gap,mouth opening, Mallampati grading, head and neck movement, horizontal length of mandible, sternomental distance , and thyromental distance facilitate in  predicting a difficult intubation ,none of the test offers one hundred percent positive predictive value(Rajesh MC et al 2015).Despite the criticism,Burtenshaw (2015) states Mallampatti score is widely used and score of 1 to 4 dictates the view of the patients tongue,faucial pillars, uvula and posterior pharynx. Score of 3 or above is associated with limited views at laryngoscopy. But a recent study by JigishaPrahladrai et al (2016) found out upper lip bite test (ULBT) and the ratio of height to thyromentaldistance (RHTMD) as the most reliable airway assessment tools. The anaesthetist used a combination of airway assessment techniques for Jane which included mallampatti and ULBT. Jane’smallampatti score was one, which indicated it would not be a difficult to manage her airway,however; a difficult intubation trolley is always kept in theatres in the event of an emergency.Jane was then asked about the state of her teeth as loose or damaged tooth that can compromise the airway (Allman 2015). Jane had no loose teeth or dentures.The anaesthetist chose a supraglottic airway devise to manage Jane’s airway (Sosa-Jaime et al 2009).

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