[Anesthetic management of a patient with abdominal aortic aneurysm (AAA) with giant bulla]

We report a case of abdominal aortic aneurysm with giant bulla in a 58-year-old man who had an elective abdominal aortic reconstruction surgery. Preoperative chest x-ray showed a giant bulla in the right lung and small bullae in the left. General anesthesia was induced with midazolam 0.5 mg, fentanyl 0.2 mg and succinylcholine chloride 80 mg. After tracheal intubation, anesthesia was maintained under spontaneous breathing with halothane 0.5-1% in a mixture of air and oxygen (FIO2 0.4-1.0) supplemented with continuous epidural mepivacaine from the catheter inserted the day before surgery. Since satisfactory analgesia and muscle relaxation were achieved by epidural mepivacaine, no analgesics and muscle relaxants were administered during the operation. Postoperatively, no complications occurred and the patient was extubated and transferred to the intensive care unit. We emphasize that combined epidural and light general anesthesia with spontaneous respiration might be ideal for the safe anesthetic management of a patient with a giant bulla.