Hi all, been awhile since I posted but I thought I had a great case to discuss. Anyway, on to the details...

64 y old female, 5'9", 101 kg, BMI 33.

H/O MI 2012, CABG 2012, CAD, COPD, smoker, 3L O2, OSA, arthritis neck and spine, GERD, anxiety disorder. Pt states that she has an ongoing MERSA infection in her stermum, recently had the top wire removed and finished her last course of antibiotics. Also, she cannot tolerate lying less than 30 deg. SaO2 is 94% with NC. She has recently been diagnosed with carotid stenosis, 90% left, 85% right with no symptoms. Case is booked for left sided carotid endarectomy.

Uneventful induction/intubation and pt is stable throughout surgery. After surgeon unclamps IC, he does an US and doppler of artery and doesn't like what he sees/hears. He reopens and dilates the artery, closes again and is satisfied with the result.

How would you wake this pt up? I'll tell you my plan and how well it didn't work after I get a few responses.