I had an interesting case the other night. I'm asked to evaluate a 43- year old woman for tooth extraction the next day. Her medical history is 25 pack-year smoker and morbid obesity. She is 390# with a BMI of 55. CT of neck shows abscess/cellulitis of deep tissue structures posterior to mandible. She has tremendous pain and is unable to open her mouth much more than 1.5 FB. Anyway, I formulate a plan and discuss with patient and she agrees. At 2300 I get a call from ENT who says she has adenoid swelling that has progressed and needs to go to surgery now. He wants to trach her and have dental extract the tooth. This is small rural hospital at almost midnight and you are the sole anesthesia provider...although it was awesome ENT was involved and available. What would be the plan?