Combination of intravenous dexmedetomidine with topicalization of airway for placement of double lumen tube in a spontaneously breathing patient of giant lung bullae

Giant bulla; Pneumothorax; Anaesthesia management; Spontaneous breathing; Dexmedetomidine Abstract Lung bulla occupying more than 30% of hemithorax is described as giant bulla which is now treated surgically with positive outcomes. During intraoperative period, these patients are vulnerable to hyperinflation, hypoxia and hypercarbia due to significantly increased dead space and reduced functional alveoli, gas exchange and oxygen reserve. Real hazard is rupture of bulla, which can lead to life threatening tension pneumothorax if it occurs before lung isolation. Hence, a technique of induction wherein spontaneous breathing is maintained is thought to be ideal. Here we present a patient with giant lung bulla in left lower lobe with severely reduced pulmonary reserves and significant air-trapping posted for VAT assisted bullectomy. Anaesthesia challenges including pathological changes, its effects during induction of anaesthesia, and issues related to placement of double lumen tube in a spontaneously breathing patient are discussed with possible advantages of dexmedetomidine in this special group of patients. 2016 Publishing services by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).