Anaesthesia for bullectomy

A patient with severe bullous emphysema in whom one bulla occupied more than 25% of the hemithorax, with a shift of the mediastinum to the opposite side, was anaesthetised for bullectomy with a combination of intravenous gamma-hydroxybutyric acid and a high thoracic extradural catheter technique. During the operation the patient breathed 100% oxygen through a double-lumen endobronchial tube in the lateral thoracotomy position. Extradural analgesia during the operation was provided by bupivacaine 0.25%, with adrenaline 1:200 000 and, postoperatively, with nicomorphine diluted in dextrose 5%. The advantages of this technique are described.