标题：Perioperative and postoperative pain relief in a reduction mammoplasty using ultrasound-guided pectoral nerve block: A firsthand experience by a young anesthetist
摘要：We encountered a case of a 47-year-old female weighing 77 kg posted for bilateral reduction mammoplasty. The patient had cervical spondylosis for the last 10 years but was not on any medication for that. She had undergone total abdominal hysterectomy 16 years back under general anesthesia. The patient was accepted for surgery in the American Society of Anesthesiologists Class II in view of obesity and difficult airway. The patient was given diazepam tablet 5 mg HS on the night prior to surgery. Preoperatively,the patient's blood sugar was 112 mg/dl and serum electrolytes were within normal limits. Monitoring was started with electrocardiogram (ECG),SpO2,noninvasive blood pressure (NIBP),end-tidal CO2 (EtCO2),and skin probe for temperature. Premedication given was injection glycopyrrolate 0.2 mg intravenously (IV),injection ondansetron 4 mg IV,injection midazolam 1 mg IV,and injection fentanyl 60 mcg IV. Preoxygenation was done with 100% oxygen for 3 min. Induction was done with injection propofol 140 mg IV. After confirming ventilation,injection rocuronium 70 mg IV was given. Intubation was possible in the second attempt with the help of a bougie (Cormack–Lehane class III) using no. 7.5 endotracheal tube (ETT). After confirming equal air entry on both sides of the chest,the ETT was fixed at the right angle of the mouth. Maintenance of anesthesia was done with O2,N2O,sevoflurane,and atracurium.
