Anaesthetic Challenges in Thoracic Spine Surgery with Bilateral Pulmonary Bullae: A Case Report with Literature Review

Bullae are thin walled, air filled intraparenchymal lung spaces which carries a significant risk of life-threatening complications during the perioperative period. To avoid the risk of rupture, most experts recommend the use of spontaneous ventilation or regional anaesthesia during the intraoperative period. We present the anaesthetic management of an elderly smoker with bilateral pulmonary bullae, poorly controlled diabetes, and hypertension, posted for excision of a thoracic-spine tumour under the prone position, requiring need for general anaesthesia with positive pressure ventilation. This literature review highlights the steps for pre-operative evaluation, anaesthesia planning, precautionary measures, and the protocol to be followed in the event of complications.