Anaesthesia for thoracoscopic pleurectomy and ligation of bullae

Summary A patient is described who, despite severe pre-operative respiratory disability, had her persistent pneumothorax successfully managed by thoracoscopic pleurectomy. The technique causes considerably less pain and interference with respiratory function postoperatively than does conventional thoracotomy. Potential anaesthetic problems arise because of the necessity of insufflating carbon dioxide at pressures of up to 1 kPa to maintain a pneumothorax during surgery.