To perform lung biopsy by video assisted thoracoscopy(VAT)for the diagnosis of interstitial lung disease (ILD) of undetermined etiology in spontaneously breathing patients. Lung biopsy was done under thoracic epidural and stellate ganglion block. Intubation was avoided in these cases as the disease is bilateral and poses a potential risk for general anesthesia.Lung biopsy is the gold standard for the diagnosis and appropriate management of interstitial lung disease

Lung biopsy was performed in 6 cases. Patient was pre-medicated with intravenous fentanyl 1mcg/kg and midazolam 30mcg/kg with oxygen supplementation. Thoracic epidural anesthesia was instituted between T5-T6 space. In addition, stellate ganglion block was performed to achieve cough control. This is supplemented with local anesthetic instillation after thoracoscopy for effective suppression of cough reflex.

Lung biopsy was performed in six cases with interstitial lung disease of undetermined etiology. All the patients were comfortable during the procedure. Cough was effectively suppressed by ipsilateral stellate ganglion block and blunting of vagal response by intraoperative instillation of lignocaine. One patient developed continuous air leak during postoperative period for two weeks.

We can conclude that lung biopsy and other short intrathoracic procedures can be safely performed in a spontaneously breathing patient by adapting regional block techniques thereby avoiding general endotracheal anaesthesia. Patients can be discharged soon, hence reducing the postoperative hospital stay as well as hospital costs. However the study group is small to claim the advantages of conducting VAT in spontaneously breathing patients, but the recommendations is evidence based.