AbstractRadiotherapy is a commonly employed and an important modality of treatment for cancer with about 50 % of the patients receiving radiotherapy during their course of treatment.1 Two major categories for the application of radiation are external beam radiation and brachytherapy.1 Brachytherapy is derived from the greek word brachys meaning “short distance”.2 Brachytherapy is administered by inserting a radiation source inside a specific cancer site which needs anesthesia, analgesia and muscle relaxation. The theory behind brachytherapy is to deliver low intensity radiation over an extended period to a relatively small volume of tissue covering the tumour area and sparing the surrounding normal tissue. The demand for anesthesia in brachytherapy is increasing nowadays. Anesthetic management is crucial because it poses a number of challenges for the anesthesiologist. Patients for brachytherapy are often elderly and are high risk patients with multiple co morbidities, brachytherapy for head and neck malignancy may pose the problem of difficult airway, to achieve a stable position of the applicators and implants immobilization is essential.3 Brachytherapy often has an unpredictable procedural duration. Transportation of the anesthetized patients to different radiological suite is a typical challenge.3 Various modalities of anesthesia employed include general, spinal, combined spinal epidural anesthesia and local anesthesia with sedation. Anesthesiologist play a major and an important role in the ongoing challenge to provide an optimal treatment conditions for brachytherapy.