Anesthesia management for giant pulmonary bullae during emergency intracranial aneurysm embolization: a case report

An intracranial aneurysm with an acute subarachnoid hemorrhage is an acute neurosurgical disease that often requires emergency surgical intervention. A patient with giant pulmonary bullae is usually elderly and has consistently resisted any surgery, so general anesthesia is required. However, anesthesia management in patients with pulmonary bullae is challenging due to the possibility of spontaneous pneumothorax, a serious complication. Thus, these patients require careful preoperative evaluation and intraoperative management to ensure rapid recovery and minimize adverse effects from anesthesia.

A 76-year-old female patient had giant pulmonary bullae and resisted emergency intracranial aneurysm embolization. The patient underwent rapid anesthesia induction after breathing normally through the mask for 5 minutes. A left dual-lumen tracheal catheter No. 33 was quickly inserted and positioned using an electronic fiber bronchoscope. The tracheal catheter was removed under deep anesthesia and replaced with a 3.0 laryngeal mask after the operation. The patient was fully awake and her laryngeal mask was removed. The patient reported no discomfort and was sent back to the ward.

We report the case of a patient with giant pulmonary bullae who underwent emergency non-lung surgery associated with a possible serious complication who was successfully treated with general anesthesia. This approach can be used for patients with similar conditions.