Had an interesting case so figured would post and see what the students thought and then to gain the insight of the wise veterans =D. I was lucky enough to have a case cancel and get this as an add on I knew nothing about until I went in seen him in ICU.

25 yo male for flexible bronchoscopy, tracheal stent removal and replacement.
Hx CVA 7/2010. Left side weakness. Failed to wean, bought a trach. Trach was d/c'd couple months ago.
DVT and PE hx 2005. Diagnosed with MTHFR.
Obesity 120 kg, 6'3"
Pt was hospitalized 2/11 with SOB--found to have tracheal stenosis--went to OR stent placed. 2/13 stent thought to migrate causing resp problems--back to OR, certain equipment not available (bigger stent or guide) so they left pt intubated (6.0 tube due to stenosis and resolving edema) took him to ICU with plan to bring back on 2/14. Pt was EZ mask with oral airway. Grade 2 view with laryngoscopy.

Pt takes "alot" for sedation, so in ICU (~1400 2/13), pt placed on:
propofol gtt 50 mcg/kg/min
vecuronium gtt 1.7 mcg/kg/min
versed 4 mg/hr.
Vent setting IMV 14, TV 700 40%fio2, peep 5, ps10. pox 98%. pulse 80 BP 94/55 temp 36.9 Labs unremarkable except INR (pt on coumadin due to clotting disorder).
Other meds labetolol, protonix, lisinopril, insulin gtt, advair

You see the surgeon and the surgeon tells you that he already talked to anesthesia yesterday and the plan is to take out stent that has migrated, replace stent and then wake pt up because replacing ETT after new stent in will dislodge it.

Thoughts and plan?