Anaesthetic Management of a Patient with Giant Pulmonary Bullae for Surgical Resection of Carcinoma Upper Alveolus: A Case Report

Abstract

Patients with incidental bullous lesion of lung occasionally present for non-thoracic surgeries, these patients are at increased risk of potential complications which can arise due to bullae, during perioperative period. Anaesthetic management of these patients planned for a major non-lung volume reduction surgery is challenging as it is rare and requires careful understanding of anatomical and pathophysiological variation of disease. Safe conduct of anaesthesia can be delivered without isolation of the lung or sub-segment in which bulla is involved in these patients so that perioperative respiratory crippling conditions like pneumothorax, emphysema, atelectasis of the surrounding lung parenchyma leading to postoperative respiratory failure can be avoided. Eternal vigilance, monitoring, ventilator strategies are required to avoid possible perioperative complications and a successful outcome, few essential precautionary measures to be taken include vigilant monitoring of patient perioperatively, avoidance of nitrous oxide, low airway pressures, immediate availability of chest drains, periodic auscultation of chest, arterial blood gas analysis. Here, the present authors report a successful perioperative anaesthetic management of a patient with giant bulla in left upper lobe and right upper lobe developed as post tubercular sequelae that underwent inferior partial maxillectomy with neck dissection and reconstruction for carcinoma upper alveolus without isolation of lung.

Keywords

• malignant airway
• non-thoracic surgery
• oncoanaesthesia