ANAESTHESIA CONSIDERATIONS OF A PATIENT WITH LARGE BULLOUS LUNG DISEASE- A CASE REPORT.

Introduction: A bulla is defined as an intraparenchymal air-filled space of more than 2 cm in diameter in distended state within the lung which has developed because of emphysematous destruction of the lung parenchyma and loss of alveolar structural tissue. Indications for surgical resection of bullae include incapacitating dyspnea, a large bulla that fills >30% of the hemithorax, as seen in this case. Patients with Lung emphysematous bulla are at increased perioperative risk of rupture & barotrauma resulting in tension pneumothorax & compromised respiratory status. After a meticulous clinical and radiological assessment, patients with bullae can be taken up for surgeries like local excision/bullectomy, lobectomy, segmental resection, and minimal access surgeries. Case Report: We present an atypical case of a 26-year-old female with a large bulla measuring 16 x 21 x17cm arising from left lower lobe with centrilobular emphysema with passive collapse of left upper lobe and gross mediastinal shift to the right, managed successfully using lung isolation technique and peri-operative pain management. Conclusion: Anaesthetic management of a patient with lung bulla is challenging. Anesthesiologist should deliberate over an extensive preoperative assessment to identify the high-risk factors, reversibility of underlying lung pathology, need and dependency on mechanical ventilation, and establish a successful perioperative management plan for a smooth, pain free post-operative recovery in such patients. In this case, we describe the anaesthetic considerations of a patient with multiple large lung bullae underwent elective bullectomy under general anaesthesia. No serious complications occurred during intraoperative and postoperative course. [ABSTRACT FROM AUTHOR]