Anaesthetic management of a case of alveolar proteinosis

Pulmonary alveolar proteinosis is a rare type of interstitial lung disease characterised by diffuse involvement and filling of distal air spaces by the amorphous, periodic-acid-schiff positive lipoproteinaceous material. Whole lung lavage is presently the standard mode of management of such cases. A 33-year-old male presented to our centre with cough and breathlessness on exertion. On evaluation he was found to have PAP. He underwent whole lung lavage (WLL) under general anaesthesia using one lung ventilation. We describe the anaesthetic consideration and the challenges faced in such a procedure.