Cervical epidural anesthesia for breast surgery has been described in a few trials on patients in good physical condition. The real benefits of replacing routine general anesthesia with a regional approach have not been reported in patients with diminished respiratory reserve. This case report describes the successful use of cervical epidural anesthesia in a patient with severe respiratory failure. A 72-year-old female patient with carcinoma of the right breast with coexistence of severe chronic obstructive airway disease (COAD) was scheduled to undergo a modified radical mastectomy with axillary clearance. After discussion with the surgical team, cervical epidural anesthesia was planned to provide adequate dermatomal anesthesia for the surgery. The patient received dexmedetomidine as sedation during surgery. Despite concerns about bilateral phrenic nerve palsy and associated decrease in vital capacity, carefully conducted cervical epidural anesthesia may be used in patients with respiratory failure undergoing major breast surgery. Key words: mastectomy, epidural anesthesia, dexmedetomidine. Key message: Cervical epidural anesthesia is a safe and useful tool for patients with severe respiratory disease undergoing major breast surgery and offers a significant advantage over general anesthesia. IntroductionThe traditional anesthetic approach for radical breast surgery is general anesthesia. Various studies and case reports have described the use of regional techniques either for postoperative analgesia or as the sole anesthesia technique for this surgery. Cervical epidural anesthesia is most likely to obviate the need for general anesthesia supplementation as it can cause dermatomal spread from C3 to T8 allowing the axis...... middle of paper ..... Inspiratory vital capacity (IVC), vital capacity (FVC), FVC, FEV and FEF were found to be decreased by 18% at 20 min and by 12% at 50 min and the FEV:FVC ratio was maintained within. normal limits. We administered the local anesthetic in small aliquots titrating to the desired block level and experienced no significant reduction in respiratory excursions; respiratory rate was only slightly increased from 18 to 22. Dexmedetomidine was used to provide conscious sedation. Paris A, Tonner PH [6] in their drug review concluded that dexmedetomidine provides dose-dependent sedation, analgesia, sympatholysis and anxiolysis without relevant respiratory depression. Conclusion Cervical epidural anesthesia, when used cautiously, may be helpful in patients with preoperative respiratory failure. This may improve postoperative outcomes with a reduction in respiratory complications.