Anaesthetic management of a breast cancer patient with cardiac tamponade and bilateral vocal cord paralysis

Metastatic breast cancer presenting with both cardiac tamponade and bilateral vocal cord paralysis is rare. We report a case of an elderly patient with breast cancer who had previously undergone right modified radical mastectomy and then presented with cardiac tamponade and recurrent laryngeal nerve paralysis as complications of the malignancy. She underwent right anterior thoracotomy, pleuropericardial window, left tube thoracostomy and tracheostomy under general anaesthesia. Anaesthetic goal was to secure a potentially difficult airway caused by reduced glottic dimensions secondary to bilateral vocal cord paralysis, while simultaneously maintaining preload, systemic vascular resistance and oxygenation, given the presence of cardiac tamponade. This case highlights a rare presentation of advanced breast cancer and emphasises the devastating implications of these conditions for patients, thus warranting further discussion on their anaesthetic management.