Review Note

SS_PB 1.5 Discuss the surgical requirements and implications for the perioperative anaesthetic management of patients having:

• Patient Profile: Typically women aged 20-40 years with associated neck and back pain due to large breast size.
• Anesthesia: IPPV (intermittent positive pressure ventilation) is preferred since the surgeon often applies pressure to the chest wall, ensuring adequate chest expansion and control of PaCO2.
• Blood Loss: The amount of bleeding depends on the surgical technique used. Cutting diathermy tends to cause less bleeding than a scalpel. Massive breast reduction (>1 kg tissue removal per breast) is associated with significant blood loss.
• Postoperative Pain: Typically, pain is not significant and can be managed with regular simple analgesics (e.g., paracetamol, NSAIDs) and PRN opioids.

• Indications: Performed for reconstruction after mastectomy, correction of breast asymmetry, or aesthetic bilateral augmentation.
• Patient Profile: Generally fit and well women.
• Postoperative Pain: Discomfort tends to be more significant than with breast reduction, especially with larger implants, which cause more tissue stretching and pain.

• Patient Profile: Most patients are aged 45-65 years, fit and well, with high expectations for anesthesia and surgery. Some may have had previous facelift procedures.
• Airway Management: Discuss airway devices with the surgeon; consider a throat pack if nasal surgery is involved.
• Anesthesia: A moderate hypotensive technique (SBP 70-80 mmHg) and a 30° head-up position help minimize blood loss and improve surgical conditions. Remifentanil is ideal for intraoperative analgesia and sedation.
• Emergence: Smooth emergence is critical to avoid bleeding beneath delicate suture lines. Propofol maintenance and a flexible LMA are ideal.
• Pain Management: Pain is not usually a major concern; discomfort is typically related to platysma tightening. Regular paracetamol, NSAIDs, and PRN opioids are used for pain relief