Anesthesia management in a case of restrictive lung disease especially interstitial lung disease (ILD) poses many challenges to anesthesiologists as these patients have decreased lung compliance and volumes with preservation of expiratory flow rates. These patients present with rapid and shallow breathing patterns with alteration in respiratory gas exchange and V/Q mismatch which causes an increase in perioperative complications. Case description: An 86-year-old man weighing 106 kg k/c/o diabetes and hypertension controlled on medications was posted for bilateral hernioplasty. He had been operated on for CABG and spine surgery with instrumentation at the lumbar region. The patient had shallow and rapid breathing. SpO₂ on room air 92%. PFT revealed severe restrictive pattern; chest X-ray pa view showed hazy opacities over both lung fields CT scan suggestive of interstitial pneumonia. 2D echo showed LVEF 50–55% and hypokinetic distal interventricular septum. Due to huge inguinoscrotal swelling, the inguinal block was not feasible, spine surgery was a contraindication for neuraxial block, hence general anesthesia was the technique of choice. The patient was optimized by nebulization with duolin and budecort, antiplatelets stopped as per the cardiologist's opinion. Premedication with midazolam 0.5 mg iv and fentanyl 100 μg iv. Propofol was used for induction. Intubation was done with an 8 mm ID endotracheal tube using 40 mg iv atracurium and maintained on oxygen, air, and isofluorane. The patient was converted to pressure control with pressure settings between 20 and 25 cmH₂O which delivered 300 mL tidal volume approximately. Saturation was maintained to 100% and end-tidal CO₂ remained between 32 and 35 intraoperatively. The patient was electively ventilated to reduce work of breathing in a k/c/o ILD with prolonged exposure to anesthesia, hypothermia, electrolyte imbalance as the gradual weaning process is beneficial for such patients. The anesthesia management of ILD cases requires proper preoperative assessment and optimization and proper choice of anesthesia.