Carcinoma Cervix for Pelvic Exenteration

Pelvic Exenteration is an ultraradical surgical procedure performed for centrally recurrent gynaecological cancers. This procedure is associated with a significant risk of morbidity and mortality and is usually indicated only when there is no other curative option left to cure advanced localized pelvic malignancy. The optimal approach to anaesthetic management for patients undergoing pelvic exenteration involves a skilled and dedicated multidisciplinary team with experience in the field. The patient should be thoroughly counselled about the risks and long-term surgery-related issues. The anaesthesiologist involved during the case should pre-evaluate the patient’s fitness and cardiopulmonary reserve and assess the risks involved and prepare a perioperative management plan to determine the level of surgical fitness because pelvic exenteration is a prolonged duration surgery with extensive fluid shifts that may require vasopressors, inotropes and blood product transfusion. The patient may have medical comorbidities such as heart disease, lung disease, diabetes mellitus, etc. which should be identified and managed accordingly. Avoiding hemodynamic instability due to massive haemorrhage is a major challenge for the anaesthetist. Prompt and vigorous resuscitation, incorporating intravenous fluids and blood products, is imperative to mitigate the risk of complications. Multimodal analgesia with opioid-sparing techniques (e.g., epidural analgesia), prevention of hypothermia, early mobilization after surgery, etc., leads to better patient outcomes.