Anesthetic management of a patient with giant bullous emphysema undergoing posterior fossa surgery: A case report

In this case report, we detail the anesthetic management of a patient with Giant Bullous Emphysema (GBE) secondary to smoking undergoing craniotomy for a posterior fossa lesion in the prone position, with head immobilization using skull pins. GBE poses significant anesthetic challenges due to compromised lung function and risk of bullae rupture. With the impracticality of spontaneous ventilation owing to the surgical positioning and duration of surgery, our approach prioritized meticulous ventilation control with permissive hypercapnia striking a balance between brain relaxation and levels of intrathoracic pressure. There was immediate availability of X-ray imaging and chest drains in case of bullae rupture. There are limited reports in the literature regarding the anesthetic management for patients with GBE undergoing non-thoracic surgery and we discuss the physiological challenges of these cases.