Retrograde intubation is an invaluable technique which can be helpful in anticipated difficult airway situation. In this advanced era where fiberoptic intubation and video laryngoscopes are in abundant use, retrograde intubation is a forgotten technique. However, it may be useful in various difficult airway situations in this advanced era. In our case the patient had a bitter experience with previous fiberoptic intubation. Owing to that we had planned and performed a fiber optic guided retrograde intubation, where we had kept the fiberoptic bronchoscope in the pharynx keeping larynx and vocal cords in the focus to facilitate the emergence of guide wire through one of the nostrils as well as direct visual confirmation of intubation. This fiber optic guided retrograde intubation is a first reported case of its kind in a predicted difficult airway which can be beneficial in different difficult airway situations.

Introduction: Surgical palliation of malignancy is defined best as a procedure used with the primary intention of improving Quality of Life (QoL) or relieving symptoms caused by an advanced malignancy. Surgical procedures for palliation include resections, reconstruction, functional repairs, drainage, and biopsy. Primary benefits include QoL improvement through symptom prevention or control, with survival advantage as a secondary benefit. Aim: To evaluate mortality (30 days and 6 months), length of hospital stay and Intensive Care Unit (ICU) stay and QoL among patients undergoing palliative surgery for advanced cancer. Materials and Methods: A retrospective study was conducted at Dr. B. Borooah Cancer Institute, India, from September 2020 to March 2021. The clinicodemographic profile, tumour type and staging, treatment, investigations, surgery, anaesthesia and complications were studied. The outcome was defined by mortality, length of hospital stay and quality of life. Descriptive statistics was used for analysis. A p-value of less than 0.05 was considered significant at 5% level of significance. Results: A total of 86 patients underwent palliative surgeries, out of which 52 (60.5%) were females and 34 (39.5%) were males with the mean age of 49.6±15.9 years. Among them, 8 (9.3%) died within 30 days of surgery and 11 (12.8%) at six months after surgery. There was a significant association of mortality with pallor, deranged Thyroid Stimulating Hormone (TSH), co-morbidities, chemotherapy, type of surgery and anaesthesia but not with age, sex, type and stage of cancer, American Society of Anaesthesiology (ASA) status and General Condition (GC) of the patient. The mean duration of postoperative hospital stay was 15.8 days and mean ICU stay was 0.8 day for all patients. Patients with pallor had longer duration of hospital and ICU stay. Type of surgery was significantly associated with hospital stay but not with ICU stay. On evaluating the quality of life using Eastern Cooperative Oncology Group (ECOG) score, it was seen that the number of patients with poor ECOG scores (3 to 5) increased significantly from 10 (11.63%) to 13 (15.12%) in the immediate postoperative period. Conclusion: Patient factors affected the outcome after palliative surgery more than surgical and anaesthetic factors. The high mortality rate of 12.8% warrants detailed prospective studies in the future.

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can significantly influence overall and disease-free survival in selected patients suffering from peritoneal surface malignancies (PSMs). We report here the anaesthetic management of a 52 year old patient of Ca Colon with secondary ovarian and peritoneal deposits. She underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with curative intent. The advent of CRS/HIPEC gives a promising alternative to conventional treatment modalities but comes with numerous challenges to the anesthesiologist—in view of the metabolic and hemodynamic adjustments—and demands training.

Osteosarcoma is the most common bone sarcoma having an incidence of 4.6 per million occurring more commonly in the adolescent age group. Treatment of osteosarcoma consists of neoadjuvant chemotherapy for about 10 weeks before and after the reconstructive surgery carried out to salvage the affected limb. The limb saving surgical treatment of osteosarcoma consists of tumour resection and limb reconstruction with a bone graft or endoprosthesis. We hereby discuss the anaesthetic management of a young adult with distal femur osteosarcoma posted for tumour resection and implant of an endoprosthesis with the help of general anaesthesia with adequate perioperative pain management with systemic opioids, paracetamol and epidural analgesia. Optimal haemodynamic management with the help of invasive monitoring helped us not only to manage the perioperative fluid requirements but also kept us vigilant against any untoward side effects of bone cement implantation syndrome. Use of low molecular weight heparin also helped us achieve adequate thrombophrophylaxis in the post-operative period.