Anesthetic Management of Modified Radical Mastectomy in a Patient With Severe Dilated Cardiomyopathy: A Case Report

This case report presents the successful anesthetic management of an 84-year-old woman with severe dilated cardiomyopathy (ejection fraction: 25-30%), atrial fibrillation, and recent angina, undergoing a modified radical mastectomy. Given the risks associated with general anesthesia in this patient due to poor cardiac reserve, a combined regional technique was chosen. Ultrasound-assisted thoracic epidural anesthesia and supraclavicular brachial plexus block were administered, achieving complete anesthesia of the surgical field while maintaining stable hemodynamics throughout the procedure. Careful incremental dosing of bupivacaine supplemented with lignocaine-adrenaline, along with vigilant monitoring, prevented hypotension and arrhythmias. The patient had an uneventful intraoperative and postoperative course and was discharged on the seventh postoperative day. This case highlights the efficacy and safety of dual regional anesthesia in high-risk cardiac patients, reinforcing the role of individualized, ultrasound-guided regional techniques as viable alternatives to general anesthesia in select surgical scenarios.