Well seems like we dont do this a lot these days - so let talk about case prep and intraop-management..how would you like to do it...?

69 yo Female, s/p Endovascular AAA - presenting for repair for small leak & alterations in renal, mesenteric and LE blood flow post op (1 days).

5' 2 104 kg, Preop VSS, K 3.6, NA 138, Creat 1.4, Hem 12, Plat 225, AG 8, INR 1.2, BS 107

PMH: AFlut/Fib, HTN, MI (6 yo) s/p 3 stents in 2006, CHF, PE, COPD, DM, Rh Arthr

PSH: x2 TKA, Chole, endovasc AAA, stents

ALL: ASA

Meds: Glucophage, Metoprolol, Dig, Coumadin (stopped 7 days priro to adm), Advair, Methotrexate, MS contin

Consults: NSR, CXR clear, Echo: Recent cardiac workup (Stress and Echo): moderate AI/MR EF 43%, fixed old apical septal wall defect without ECG changes - currently in NSR with old MI indications in V 2- 4.

ROS: Obese female with limited exertional capacity with significant cardiopulmonary and vascular pathology as listed above. CHF resolved 6 months prior. Denies recent SOB, PND, or orthopnea. GERD. +2 Systolic Murmur + S3. Rest of eval is unremarkable. Difficult to palpate pulses.

Airway MP 4, thick neck, full teeth, small mouth - FROM.

Concerns?