30 y/o F 55kg with history of Myotonic Dystrophy presents to ASC for multiple scalp cyst removal.

PMH and Physical Exam:
Dad states has valve problems and when asked he said they've been told she has had a murmur all her life, but not on anything for it
Able to stand and walk a few steps, but not able to walk very far
Severe developmental delay (seemed to have mind of an 8-10 yr old who is very anxious)
MP 1, FROM, endentulous
EKG shows left fasicular block

The preop RN attempted to start an IV and the girl went nuts, screaming and obviously very anxious and that was just with the RN setting up for the IV.

What is your plan for this case and how will you prepare? What are your concerns? If you have any questions feel free to ask and I'll try to fill in the missing pieces.