From a purely logistical standpoint, it *would* be difficult to have this
mom's breasts expressed during surgery.  Not impossible, but difficult.  I
would guess that mom may be positioned in a modified sitting position to
allow for posterior skull base surgical access, and there will be extensive
draping over her entire body as well as multiple tables of surgical
instruments crowded right up next to the OR table/chair.  Mom may also get a
subclavian central line placed so there will be 2 or 3 IV lines draped
across her chest.  When doing neuroanesthesia cases, I have a hard time
ducking under the drapes and just trying to locate and troubleshoot finicky
radial arterial lines or peripheral IVs for 30 seconds -- and the surgeons
are sometimes not so excited about that if I have to interrupt what they're
doing at all.  Maintaining sterility can be tricky as well.  It's just
really hard to get to *anything* on the patient except the feet.

Mom's best bet here would be to get the hospital LC to agree to be available
to come in and hand-express at natural "breaks" during the surgical flow --
likely with only a few moments notice.  Neurosurgical cases tend to be very
high stress (just the palpable feeling in the room!) and honestly, thinking
about this mom's breasts is not going to be high on priority list for either
the surgeons or the anesthesiologist.  But I think it's do-able.  If she
were at my hospital, I'd figure out how to make it work.  The key will be
making it as "non-invasive" or interruptive as possible to the surgeon.

Recovery from tumor resections tends to be highly variable -- I've had many
patients wake right up, extubated in the OR, and drowsy but talking in the
PACU (again, post-anesthesia care unit). :)  Others have received enough
narcotic or sometimes benzodiazepines depending on if the surgeon requests
burst suppression (they sometimes want the patient's brain waves to be
flat-lined for parts of the surgery) that they remain intubated until the
next day.  And often, if a surgery is very lengthy (10+ hours) and there is
any question about the patient's airway or neurologic status, we will leave
them intubated and sedated overnight so as not to have an emergency occur at
night when there are fewer people around to help out.  But quite honestly,
I'm usually pleasantly surprised with how "with it" these patients already
are in the PACU.  And somewhat surprisingly, post-op pain for these kinds of
cases is usually not bad.  

Good luck to this mom.  I hope she can get the surgeon and other staff on board.

-Sarah Reece-Stremtan M.D. (anesthesia resident currently on "breastfeeding
leave")

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