Modified radical mastectomy, the standard surgical procedure in the management of carcinoma of breast is routinely performed under general anaesthesia. Carcinoma breasts patients are considered to be at high risk for anaesthesia due to high possibility of perioperartive complications and mortality when associated COPD with other co morbidities. Here we present a case report of successful perioperative management of modified radical mastectomy only with thoracic epidural anesthesia in a diagnosed case of carcinoma of breast with COPD, hypertension, type 2 diabetes mellitus . case report: A 58-year-old female, a known case of chronic obstructive pulmonary disease since five years with comorbidites (ASA grade III), presented with carcinoma of breast was scheduled for modified radical resection. Continuous thoracic epidural anesthesia was administered at T4-5 level. Local anesthetic supplementation titrated as per the demands of surgery and postoperative analgesia for 48 hours. chromic obstructive pulmonary disease has been considered as independent risk factor for postoperative morbidity and mortality because of cardiopulmonary complications. but thoracic epidural anesthesia, one of the regional anesthesia techniques, with use of low dose of local anesthetic helps preserving respiratory function. the procedure was well tolerated without cardiopulmonary complications which lead to prompt recovery with additional effect of prolonged postoperative analgesia. conclusion: thoracic epidural anesthesia provided not only hemodynamic, cardiopulmonary stability but also adequate anesthesia, analgesia and satisfaction to patient in postoperative phase. It proved to be an excellent anesthesia technique for modified radical mastectomy in patient with chronic obstructive pulmonary disease.

In diabetic patients, managing the glycemic levels in the perioperative period is challenging. Surgical stress and anesthesia have great impact on blood glucose levels, thus the healthcare professionals should be more cautious to maintain the optimal glycemic level. Almost 50% of diabetes patient undergoing surgery, has great chance of post-operative mortality when compared with normal glucose tolerant patient. In addition to this, there is 5 times greater risk of developing end organ damage and infections in uncontrolled diabetic patients. Hence, there is a need to optimize and improve the blood glycemic control before surgery. Tight glycemic control with intensive insulin therapy (IIT) has shown to reduce morbidity and mortality and improve the survival after the surgery. However, evidence suggest that severe hypoglycaemia and adverse outcomes with tight glycemic control brings its safety and efficacy into query. Hence, avoidance of hyperglycemia is clearly beneficial in the perioperative patients, although IIT continues to be standard of care, current consensus guidelines recommend less stringent glycemic goals, typically between 80-150mg|dl.

Foam sclerotherapy as a surgical procedure for varicose vein has increased in popularity because it is easier, minimally invasive, early ambulation, less post operative morbidity and mortality and less complications. It can treat superficial veins, small and great saphenous vein varicosities as well as incompetent perforators, advanced varicosities with skin lesions and ulcers, by sclerosant agent injection directly with or without the help of vascular ultrasound in obese individuals, in thin veins and in difficulty to access the veins during injection of foam. Study was performed by the anaesthesiology department using general anaesthesia for patient comfort, early ambulation and discharge, avoiding regional anaesthesia.