Significant number of patients undergoing ent operations have pre existing medical illness like Hypertension, DM etc. the final outcome of the surgery depends on the intraoperative management of blood pressure as seen in figure 1, smooth recovery from anesthesia and management of the airway. In our institute well experienced anesthetists handle these issues smoothly by using a standardized pre operative protocol of balanced premedication, smooth induction of anesthesia and recovery.

Fig.1 : A multi parameter monitor is a must.	Fig.2 Ventilation with mask is always done with a jaw lift.

The most common problem encountered is a sharp rise in BP during the procedure. This is controlled by using local anaesthetic infiltrations in the operation site to reduce the pain mediated stimulation. EVEN UNDER G/A TISSUE HANDLING SHOULD BE VERY GENTLE LIKE L/A. This also means less G/A drugs usage keeping the safety margin high. Post extubation problems like breathing difficulty are managed by using the mask ventilation with a jaw lift to prevent tongue fall until the patient has FULLY recovered from anesthesia as seen in figure 2. In our set up the patient is kept in the post op ward attached to the OT at least for 4 hours so that we can reach the patient quickly in case of any recovery problems. The treatment of the patient starts from the time of admission to discharge. We tend to use antihypertensive and anxiolytics drugs even in borderline hypertensives 10 days before surgery so that sharp anxiety induced bp raises are avoided. Pre op steroids in nasal surgery do well when diuretics are added .Cases like Obstructive sleep apnoea need special care during post op period. Along with L/A drugs for local infiltration we also use steroids and in the post op period will keep them with nasotracheal intubation with a small et tube for 6-8 hours.These steps are important when we undertake major airway widening procedures like island mandibulotomy and hyoid suspension.