Anesthesia Management of Bullous Emphysema in Patient Candidate for Craniotomy

Many patients with emphysema will develop cystic air spaces in the lung parenchyma known as 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. CasePresentation: 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.