Patient in for a TURP. 61 year old history of BPH, Alzheimer's, asthma, stroke, unexplained vasovagal episode (cardiology worked up and cleared),30% LAD occlusion.... Meds include Aricept, albuterol inhaler, tamsulosin, finasteride. Induced with 130 mg propofol, 50 mcg fentanyl, on sevoflurane 2%, LMA placed. 20 minutes into procedure I hear from the other side of the drapes "The patient is moving his legs!" From my vantage point upper body, arms, head etc all completely still. Quickly give 40 mg propofol, increase sevo (was at a Mac of 1.2 when moved) and then 50 mcg of fentanyl. A few minutes later the shaking stops, the procedure continues. Pt is on 1.4 Mac, five minutes later he's moving his legs again (they were shaking - tremor -like movements). More propofol, more fentanyl, more agent. Now BP is in the toilet and the anesthesiologist walks in the room saying 'how's it going?' Argh! I had been watching all the patient's vital signs and his HR, RR, BP had never increased. My CRNA said the patient moved because he was light and it just happens sometimes. My question is, how could I have seen it and better treated it? Why did this happen? I am freaked out that this could happen again.....