A 75 year old man presented with carcinoma of the left angle of the mouth and oral cavity for excision, radical neck dissection and reconstructive surgery. He was mild hypertensive, under control on treatment and had no other systemic disease. Surgery demanded nasotracheal intubation.

The patient had a normal mouth opening and refused awake FOI. Both nostrils were patent and were prepared for nasotracheal intubation with xylometazolin; 0.05% 1ml and 1ml of 4% lidocaine. All the investigations were within normal limits. Mallampati score was grade-II.

After premedication with alprazolam 0.5mg orally on the night before the operation a 18 gauge I. V. cannula was inserted and crystalloid infusion was started and intravenous ranitidine 50mg and ondrasterone 4mg was added in the IV bottle half an hour before the operation.

On the O.T. table I/V glycopyronium 0.2 mg and fentanyl 1 g/kg^-l were given. Standard monitoring included pulse, BP, SPO₂, ECG and ETCO₂. Oxygen was given for 5 min via Mapelson'D circuit with close fitting mask followed by 4% Sevoflurane in 100% O₂ with minute ventilation of 6 liter/min. Eye lash reflex, finger tapping and arm falling were noted. Induction time taken was 122 sec. Patient was put on O₂ / Nitrous oxide (50:50) and seroflurane was decreased to 2 MAC followed by vecuronium bromide 0.l mg/Kg^-l. The lungs were ventilated for 3 min and ETCO₂ was kept at 35±3 with IPPV,' naso-tracheal intubation was facilitated with flexometallic armoured tube (cuffed) 7 mm size. BP, pulse and ECG were totally stable. SPO₂ was maintained at 99%. Thereafter, anaesthesia was maintained on O₂ / Nitrous oxide (33%:66%) with isoflurane using close circuit and ventilator, along with increments of vecuronium 0.2mg/kg and fentanyl. Both surgery and anesthesia were uneventful. The patient was transferred to the ICU for one day for observation and was extubated on the next day.

The patient was a 80 year old lady thin built and was scheduled for left cancer cheek excision and reconstruction. She was mallampati grade-I, had a normal mouth opening and was identaculous.

This patient also required naso-tracheal intubation for oral surgery and needed an ICU bed postoperatively, as a pack in the oral cavity was supposed to be kept for 48 hrs. The patient's nose was prepared with xylometazoline (0.05%) and lidocaine (4%). The patient was premedicated with alprazolam O.5mg H.S. day before operation. IV 18 gauge cannula was inserted and ringer lactate was started and IV ranitidine 25mg and ondrasterone 2mg was given half an hour before operation.

All the monitors were attached. She had a pulse rate of 70/min, BP of 110/70mmHg and R.R. of 12/min. Injection Glycoprromium 0.2mg was given along with fentanyl 1 g/kg^-l After preoxgenation for 5 min. Sevoflurane was added slowly one MAC after every three breath up to 5% and ETC02 was maintained at 35±3, induction time were noted after observing loss of eye lash reflex and finger tapping test which was found to be 90 sec. SPO₂ was maintained at 99% throughout induction. An oral airway was inserted and after assisted ventilation with sevoflurane Oxygen /nitrous oxide (50:50) and MAC was kept at 1 %. Vecuronium 2.5mg I/V was given and after 3 min of IPPV with Bain's circuit, naso-tracheal intubation was performed with flexometallic armoured cuffed tube of 6.5mm size. Intubation was smooth and there was no fall in BP or SPO₂. Anaesthesia was maintained on O₂ /N₂O (33%: 66%) with Isofturane on close circuit and ventilated. Top-up doses of vecuronium and fentanyl were given. Urine output and CVP were monitored throughout the surgery. I/M pethidine 25mg was given at end of operation and patient was shifted to ICU for assisted ventilation with sedation. After 48 hrs the pack was removed and the trachea was extubated.