Anaesthetic Management of a Case of Vanishing Lung Syndrome Undergoing Cholecystectomy

Vanishing lung syndrome is a rare radiological syndrome in which the lungs appear to be disappearing on x- ray due to giant bulla. Anaesthetic considerations in a patient with bullous lung disease undergoing a non-thoracic surgery are to prevent enlargement and rupture of bulla causing pneumothorax and maintaining adequate oxygenation and ventilation. We present a case of 62-year-old female with vanishing lung syndrome posted for cholecystectomy for symptomatic gall bladder stones. We decided to proceed with open cholecystectomy instead of laparoscopic procedure in view of giant bulla and severely impaired lung functions. Our plan of anaesthesia for open cholecystectomy was combined spinal and epidural anaesthesia which allowed us to avoid positive pressure ventilation, nitrous oxide, high airway pressures, coughing at extubation and sore throat concerns.