ABSTRACT : Improve the quality of life of a 45 year old male patient suffering from shortness of breath due to Bullous Emphysema complicated by recurrent pneumothorax. LVRS has become a novel palliative surgery for subgroup of patients with bullous emphysema. The patient was subjected to LVRS after fulfilling the criteria given in National (United States) Emphysema Treatment Trial.

METHODS : Preoperatively, the patient was optimized by pulmonary rehabilitation with incentive spirometry, chest physiotherapy, phlebotomy and improvement in nutritional status. Intraoperatively, lung isolation was done using a double lumen endobronchial tube. Intra operative and post-operative analgesia was provided by ‘Thoracic epidural catheter’. Intraoperative events including induction of anesthesia, isolation of lung, management of fluid requirements and options for ventilatory support are discussed. Possible intraoperative anesthetic complications are also reviewed, as is the optimal management of such problems, should they occur. Post-operative pulmonary rehabilitation was provided and the patient’s response was satisfactory.

RESULTS : The patient recovered well and there was significant symptomatic improvement with a probable improvement in quality of life after LVRS. Incidence of pneumothorax also is likely to come down.

CONCLUSIONS : Palliative surgeries for Bullous disease of Lung include Bullectomy and Lung Volume Reduction Surgery. The administration of anesthesia to the patients undergoing LVRS requires a complete understanding of the pathophysiology of severe chronic obstructive pulmonary disease, the planning of surgical procedure and the anticipated postoperative course for this group of patients. LVRS is an established palliative treatment and perioperative management continues to be a challenge for an anesthesiologis