Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 04 04 1544 1544 Shilpa Kore Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Aishwarya Hunashikatti Department of Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2025 12 26 2026 02 08 Geriatric patients with advanced malignancy and severe comorbidities present major perioperative challenges. We report the anesthetic management of a 70-year-old man with advanced hypopharyngeal carcinoma, triple-vessel coronary artery disease (EF 30%), and renal failure requiring urgent endoscopy for gross hematuria. Preoperative evaluation revealed creatinine 5.1 mg/dL, uremic encephalopathy, and a difficult airway due to vocal cord fixation and facial palsy. Management prioritized hemodynamic stability using etomidate induction and specific airway strategies, ensuring an uneventful procedure. This case highlights the value of multidisciplinary planning to ensure myocardial protection and airway safety in high-risk oncologic patients. https://aacc.tums.ac.ir/index.php/aacc/article/view/1544