Anesthesia Management of Bullous Emphysema in Patient Candidate for Craniotomy

Abstract

Introduction: 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. 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.

Cardiovascular Collapse after the Induction of Anesthesia Due to the MASS Effect of Unruptured Giant Bullae

“…It was decided to use succinylcholine to supply 100% oxygen for at least 3 min before the induction of In GEBs, a pneumothorax tends to occur when positive pressure ventilation is performed. The incidence of tension pneumothorax is high [4]. Therefore, we planned anesthesia to avoid positive pressure ventilation as much as possible.…”

Abdominal surgery in a patient with bullous emphysema: Anesthetic concerns

“…Emphysema is a pathological condition resulting in destruction of walls of distal airspaces, thus causing their permanent and abnormal enlargement. [1] The cystic air spaces in the lung parenchyma are known as bullae. They are formed due to loss of lung tissue providing structural support, thus resulting in elastic recoil of surrounding parenchyma.…”

“…They are formed due to loss of lung tissue providing structural support, thus resulting in elastic recoil of surrounding parenchyma. [12]…”

“…[5] Spontaneous ventilation, whenever possible, is considered the safest approach for anesthetizing these patients. [15] As the bullae are more compliant than the normal lung, they tend to fill preferentially during spontaneous ventilation. However, as the tidal volume increases beyond the normal range, the bullae tend to become much less compliant, resulting in increased airway pressures, thus causing acute rise in pressures within the bulla.…”

“…However, as the tidal volume increases beyond the normal range, the bullae tend to become much less compliant, resulting in increased airway pressures, thus causing acute rise in pressures within the bulla. [1] So when positive pressure ventilation is used, the risk of hyperinflation and rupture increases. Sudden bullae rupture intraoperatively could pose serious danger to one's life.…”