Anesthesia for bilateral volume reduction surgery in a patient with severe bullous emphysema

An 80-year-old male with severe bullous emphysema underwent bilateral volume reduction surgery. He had suffered from dyspnea and was classified into Hugh-Jones III. In spirogram, forced vital capacity in 1 second was markedly low (0.38 l, corresponding to 19.4 % in % FEV1.0). Anesthesia was maintained by isoflurane combined with thoracic-epidural anesthesia to make extubation possible at the end of surgery. We used a critical care type ventilator (Servo 900C, Simens) for pressure controlled ventilation for fear that positive pressuse ventilation creates or aggravates airleaks. Surgery and anesthesia were performed uneventfully. We recommend lower concentration of a volatile agent combine with thoracic epidural analgesia and pressure controlled ventilation for the volume reduction surgery.