Had an interesting case last night, not exactly the way I would have done it but that's what student life gets you. We did a Lap J Tube insertion under MAC. The guy had an 8cm TAA and the surgeon got in his head the best way to do the case was under MAC. Additional history of CVA and severe dementia. Started off with 2 of versed, Prop running at 25mcg/kg/min. During the case worked in some Esmolol and Metoprolol to make sure his HR and pressure didn't get out of parameters. BIS remained high 50's after induction, for what it's worth. Surgeon used lots of local for the ports and his incision. As we got started worked in some fentanyl in 25mcg increments. They ran the scope at 5 and it actually went well. They wound up opening to suture the tube in. Guy did amazingly well, received 200mcg of Fentanyl, returned to his baseline with-in about 20 minutes. As I said not my choice for how to do the case but definitely something to experience and think about.