One-lung ventilation with intentional closure of the nonventilated lumen in a patient with giant pulmonary bullae undergoing laparoscopic anterior resection: a case report

Anesthetic management of patients with giant pulmonary bullae undergoing nonthoracic laparoscopic surgery is challenging because positive pressure ventilation may further distend or rupture the bullous lung, whereas carbon dioxide (CO₂) pneumoperitoneum and Trendelenburg positioning increase ventilator demand. In conventional one-lung ventilation (OLV) with double-lumen tube (DLT), non-ventilated lumen is usually left open to ambient air. However, this may theoretically promote further bullous distension in closed-chest state. Reports of intentionally keeping the nonventilated lumen closed in this setting are limited.