Anaesthetic management of a patient with tumour-induced osteomalacia for an orthopaedic procedure.

Tumour-induced osteomalacia is a metabolic disorder that causes hypophosphataemia, resulting in bone mineralisation defects. If not treated definitively with tumour resection, this produces life-threatening anatomical changes. The anaesthetic management is tailored to address tumour location, perioperative positioning, as well as airway and pulmonary concerns.We report the anaesthesia delivery for the surgical excision of a tibial mass in a man in his late 30s with oncogenic osteomalacia. He had cervical spine deformity, pectus carinatum, severe kyphosis, lower limb atrophy with flexion contractures, severe restrictive lung disease and an inability to tolerate both lateral and sitting positions. Orthopaedic surgery was successfully done under peripheral nerve blockade and mild sedation, avoiding airway manipulation and the detrimental pulmonary effects of general anaesthesia.The physiological, anatomical and psychiatric issues governed the anaesthetic plan for the patient. While there are no established protocols for these cases, the basic goals of restfulness, analgesia, immobility and respiratory stability were achieved.