“…Bilateral emphysematous bullous disease can pose anesthetic problems such as hypoxemia, hypercarbia, bronchospasm, spontaneous rupture of the bulla, and pneumothorax. 1 In patients with bilateral bullous disease and additional empyema in one of the lungs, controlled ventilation may be hazardous because of the high risk of inducing pneumothorax on the healthy side, causing bilateral collapse of the lungs, resulting in severe hypoxia.…”