Anesthetic management of total thyroidectomy and tracheostomy in a patient with Graves’ disease and bilateral pneumothorax : a case report

General anesthesia in patients with pneumothorax without thoracic drainage requires attention to airway pressure. We present the case of a patient with Graves’ disease who was on ventilator management for right pneumothorax and left tension pneumothorax. He had bilateral pneumothorax but was managed with spontaneous breathing with only a left thoracic drain. With forced ventilation for general anesthesia, placement of a right thoracic drain was considered, but we wanted to avoid additional preoperative invasion due to his hyperthyroidism symptoms. To force-ventilate this patient without a right thoracic drain, it was important to avoid positive pressure ventilation of the right lung as much as possible. The patient underwent a total thyroidectomy with one-lung ventilation followed by a tracheostomy. After replacing the tracheostomy tube, the patient was placed on double-lung ventilation and spontaneous breathing was quickly established. This is a noteworthy case in which a small amount of remimazolam was used and a smooth transition to spontaneous breathing was achieved. This case was managed without pneumothorax exacerbation.