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Background and Aims Pulmonary alveolar proteinosis(PAP) is a rare lung disease in which there is abnormal accumulation of lipoproteinaceous material in the alveoli, leading to alveolar obstruction and hence a spectrum of respiratory illness from mild to severe respiratory failure, that usually requires Whole-lung-lavage(WLL). We are presenting our case report of a patient with PAP who underwent WLL under general anaesthesia, and discuss the anaesthetic challenges and management strategies to maintain adequate lung isolation and oxygenation, use of recruitment manoeuvres for lavage lung and the role of multidisciplinary team workup.

Conclusions A multidisciplinary team work with good communication, use of adequate backup plans, vigilant monitoring, meticulous lung separation with DLT, OLV with adequate PEEP, cautious use of positional manoeuvres and maintaining the vital parameters near or within normal range are indicators of good postoperative outcome in PAP patient.