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The O-arm® system (Medtronic Inc., Louisville, CO, USA) is a well-established technology for real-time image-guided surgery. The intraoperative O-arm system enables the precise execution of various cranial and spine surgeries.[1, 2] It can provide basic fluoroscopic images, multiplane two-dimensional (2D) fluoroscopic images, three-dimensional (3D) volumetric images and intraoperative navigation. The standard workflow for conventional intraoperative navigation includes preoperative imaging in radiology and transfer to the operating room, followed by transfer of the preoperative images to the intraoperative navigation system. O-arm–guided navigation simplifies the procedure by providing on-table preoperative imaging and immediate transfer to the navigation system for intraoperative guidance. The attending anaesthesiologist must be familiar with operation theatre (OT) ergonomics, radiation exposure and O …