NAC before cancer surgery significantly reduced physical fitness in the overall cohort. Lower baseline fitness was associated with reduced one-year-survival in patients completing NAC and surgery, but not in patients who did not complete NAC. It is possible that in some patients the harms of NAC may outweigh the benefits. Trials Registry Number: NCT01335555.

The spectrum of spinal surgery in adult life is considerable. Anaesthesia for major spinal surgery, such as spinal stabilization following trauma or neoplastic disease, or for correction of scoliosis, presents a number of challenges. The type of patients who would have been declined surgery 20 yr ago for medical reasons, are now being offered extensive procedures. They commonly have preoperative co-morbid conditions such as serious cardiovascular and respiratory impairment. Airway management may be difficult. Surgery imposes further stresses of significant blood loss, prolonged anaesthesia, and problematical postoperative pain management. The perioperative management of these patients is discussed. The advent of techniques to monitor spinal cord function has reduced postoperative neurological morbidity in these patients. The anaesthetist has an important role in facilitating these methods of monitoring.

SummaryRemifentanil is increasingly being used as the primary agent to provide sedation during awake fibreoptic nasal intubation. In this observational study, we aimed to determine the optimal effect site concentration of remifentanil, using a target controlled infusion based on the Minto pharmacological model, to provide optimal safe intubation conditions without the use of other sedatives ⁄ premedication and ⁄ or spray-as-you-go local anaesthesia. Twenty patients with anticipated difficult airway participated in the study. Good intubating conditions were achieved in all patients with mean (SD) effect site concentration of 6.3 (3.87) ng.ml )1 of remifentanil recorded at nasal endoscopy and 8.06 (3.52) ng.ml )1 during tracheal intubation. No serious adverse event occurred during any of these procedures. These preliminary findings suggest that this is a feasible and safe technique for awake fibreoptic nasal intubation.

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