Annals of Anesthesiology and Critical Care

Abstract

Introduction: Manypatients withemphysemawill develop cystic air spaces in the lung parenchymaknownas bullae. Positive pressure
ventilation increases the pressure in a bulla and increases the risk of rupture and tension pneumothorax. Therefore, anesthesia
management, for surgeries other than lung volume reduction surgery (LVRS), is challenging in these patients.
Case Presentation: A 62-year-old male patient was brought to the emergency department due to a fall resulting in head trauma and
a leak of CSF from a previous surgical site of a CP (cerebellopontine) angle tumor. The chest CT scan depicted bilateral bullae in the
lungs. Anesthesia was induced and maintained with an inhalational method using Sevoflurane and spontaneous mask ventilation.
Conclusions: Patients with bilateral bullae could be managed with spontaneous ventilation; one of the safe choices is inhalational
induction and maintenance with Sevoflurane.