Anesthetic management of a case of a lip mass with paraseptal emphysema and multiple bilateral giant bullae for surgical resection under mental nerve block

Author:

Haloi Prajnananda1,Biswas Rahul1,Bora Ananta K.1

Affiliation:

1. Department of Anesthesiology and Critical Care, GNRC Medical, North Guwahati, Assam, India

Abstract

Anesthesia in patients with emphysematous giant bulla undergoing non-thoracic surgery is challenging and can cause serious complications. We report a successful case of lip mass resection in a 65-year-old male with paraseptal emphysema and giant bullae under regional anesthesia using a mental nerve block. The patient presented with a slow-growing ulcerative mass on his lower lip and had a history of non-compliant COPD management. An excisional biopsy was planned. Preoperative workup revealed extensive lung pathology with giant bullae. General anesthesia with positive pressure ventilation in patients with emphysematous giant bullae can cause compression of lung parenchyma, vena cava kinking, circulatory collapse, and even death. To circumvent such risks, regional anesthesia was preferred and surgery was successfully done under ultrasound-guided bilateral mental nerve block. The procedure was uneventful, with stable hemodynamics throughout.

Publisher

Medknow

Reference6 articles.

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4. A unilateral large bronchopleural fistula caused by rupture of bulla with coexisting bilateral giant bullae: A case report;Kim;Anesth Pain Med,2014

5. Evaluation of bilateral mental nerve block as an alternative to general anesthesia for resection of lower lip tumors;Khater;Surg Sci,2017

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