1st case of the day, hemroidectomy. 70y patient

PMH: HTN, Hx of PE (many years ago on coumadin - bridged to lovonox), IDDM x many years (well controlled), GERD - also well controlled with PPI, slightly overweight.

Surgeon approaches me and wants to do a prone MAC (slight head down), he promises that he'll do an awesome block and he just needs the patient deep for the local. The MDA I'm with overhears this and interrupts. He says with this position any her history of IDDM we need to do GA with an ETT.

So, what do you think. Does anyone with IDDM and/or GERD not get MAC anesthesia? Does prone (and head down) reduce risk of aspiration or increase it?