Well here we go.

You have a cysto TURBT to do with a very good surgeon. He is calling it a "pluck and burn" case that will take less than 20 minutes. From your experience with him this is extremely reliable.

80 y/o

15% EF
multiple MIs in the past
Akinetic and hypokinetic LV
Pacemaker / defib

Sitting there talking to the patient he certainly does not appear as sick as his history suggests and he tells you the last time he was here for a similar procedure they did a general anesthetic where he was breathing on his own and he had no problems.

He tells you that his family doctor said they think you should do a spinal.

What do you do?