A 77-years, 35 kg, male patient with suspicious epidermoid carcinoma at his left cheek about 8x10x12cm. It fixed, looked big but bleeding-free. Because of its mass, he cannot open his mouth more than 2-3 centimeters. Generally the patient looked fine. He got mild cough in a recent couple days. Vital signs, physical examination, ecg and laboratory finding at the normal value. A chest x-ray photograph shows no pulmonary and cardiac defect, neither lung metastasis.
At the operating room vital signs show NIBP 134/78 mmhg, HR 89 /min, SpO2 96-97% didn’t arise while 3 liter per minute oxygen given via nasal canula. Premedication with antiemetic, tranexamic acid 500 mg and  phytomenadion 10 mg. So much mucous secret heard at his airway. Tracheostomy performed by the otorhinolaringologist while patient awake under local anesthetics, 50 mcg fentanyl intravenous and 50 mg pethidine in 500ml Ringer’s Lactat solution at maintenance flow.
Sedation performed with 100 mg Propofol intravenously. Maintained with halothane 0.8%, O2:N2O=50:50, without any muscle relaxing agent. For intravenous fluid resuscitation, established two i.v lines. Standard monitoring performed as routine done. At minute 70, BP fall without morphologic change of ecg. It was then maintained with fluid resuscitation and ephedrine intermittent several times. Halothane reduced to 0,6%, N2O turned-off. Blood transfusion given after 1 litre 130/0,4 colloid, while bleeding tends massively.
Operation lasts 3 hours, overall it done well. Patient then back to his ward after 30 minutes evaluated at recovery room.