We describe a case report of an 81 years old male, a case of Carcinoma left lung with multiple comorbid conditions posted for video assisted thoracoscopy surgery (VATS) SOS open thoracotomy and radical left upper lobectomy. We performed the procedure under general anaesthesia with a thoracic epidural for post-operative pain relief. CoopdechTM bronchial blocker type A with standard cuff size was used in the left main stem bronchus to achieve one lung ventilation. In this case report, we emphasise the importance of using a thoracic epidural for post-operative pain management and a bronchial blocker for lung deflation in the management of VATS, because incomplete deflation of the nondependent lung during VATS can result in poor surgical exposure and insufficient space for surgical manipulation, compromising the procedure's success. In our case, despite a good deflated operative lung, there was conversion to open thoracotomy due to adherent left bronchus to main pulmonary vessels, but with a good working thoracic epidural, we were able to extubate patient the next day in ICU due to excellent pain relief and an uneventful rest of the postoperative course, so to summarise, despite major open thoracic surgery overall good surgical outcome possible even in geriatric age group patient with multidisciplinary team approach.
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