[Combined General and Spinal-Epidural Anesthesia under Spontaneous Breathing in a Patient with a Giant Bulla]

This paper reports the successful perioperative management of a patient with a giant bulla, who underwent radical prostatectomy under general anesthesia performed under combinet spinal-epidural anesthesia while maintaining spontaneous respiration. A 61-year-old man was scheduled for radical prostatectomy. He had undergone conservative treatment using a drainage tube for right-sided pneumothorax at the age of 23. Preoperative chest CT revealed the presence of a giant bulla in the left upper lobe, multiple bullae in the entire right lung, and emphysematous alterations in both lungs. On respiratory function testing, mild obstructive impairment was observed. In the operating room, an epidural catheter was inserted at T11-12, and spinal anesthesia was performed at L3-4. Under anesthesia with propofol and fentanyl, i-gel® was inserted. During anesthesia, spontaneous respiration was managed at oxygen concentration 40% and sevoflurane 1.5%, while continuing the epidural administration of levobupivacaine. The circulatory and respiratory conditions were stable during surgery. The durations of surgical and anesthetic procedures were 2 hours and 16 minutes and 3 hours and 33 minutes, respectively. In the absence of respiratory complications, the patient was discharged 8 days after surgery.